Organization
ROOSEVELT CHILDRENS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE M. PETERS REGISTERED NURSE (REGISTERED NURSE)
(315) 331-5001
Entity
Organization
Contact information
Practice address
848 PEIRSON AVENUE, NEWARK N, NY 14513-9762
(315) 331-2086
Mailing address
848 PEIRSON AVENUE, NEWARK N, NY 14513-9762
(315) 331-2086
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
444295-1
NY
Other
Enumeration date
10/06/2008
Last updated
10/06/2008
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