Individual
SUSANA SILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9777 QUEENS BLVD PH, REGO PARK, NY 11374-3300
(718) 830-3705
Mailing address
8811 ALBERT RD, OZONE PARK, NY 11417-2708
(718) 808-2230
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
Other
Enumeration date
06/07/2012
Last updated
06/07/2012
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