Organization
OMRDD-BFFY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA CORRADO (EXECUTIVE SECRETARY)
(718) 722-6123
Entity
Organization
Contact information
Practice address
1469 FLATBUSH AVE, BROOKLYN, NY 11210-2428
(718) 253-4477
Mailing address
191 JORALEMON ST, 9TH FLOOR, BROOKLYN, NY 11201-4306
(718) 722-6038
(718) 722-6219
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01996107
—
NY
Enumeration date
02/20/2007
Last updated
08/22/2020
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