Organization
SELF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GLORIA Z. MARTIN LPN (LPN)
(347) 853-2849
Entity
Organization
Contact information
Practice address
1965 LAFAYETTE AVE, APT. 1G, BRONX, NY 10473-2502
(718) 824-0605
Mailing address
1965 LAFAYETTE AVE, APT. 1G, BRONX, NY 10473-2502
(718) 824-0605
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
273750-1
NY
Other
Enumeration date
05/23/2010
Last updated
05/23/2010
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