Individual
WURI PRIMA KUSUMASTUTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4846 47TH ST APT 4G, WOODSIDE, NY 11377-7269
(347) 239-3225
Mailing address
4846 47TH ST APT 4G, WOODSIDE, NY 11377-7269
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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