Organization
99-04 57TH AVENUE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIA E ACEBO (OWNER)
(718) 760-0471
Entity
Organization
Contact information
Practice address
9904 57TH AVE, SUITE LH, CORONA, NY 11368-3746
(718) 760-0471
(718) 760-4739
Mailing address
9904 57TH AVE, SUITE LH, CORONA, NY 11368-3746
(718) 760-0471
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0438701
NY
Other
Enumeration date
10/20/2014
Last updated
10/20/2014
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