Individual
ANCILLA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
881 LORENZ AVE, NORTH BALDWIN, NY 11510-2822
(516) 514-4793
Mailing address
881 LORENZ AVE, NORTH BALDWIN, NY 11510-2822
(516) 514-4793
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/14/2015
Last updated
10/14/2015
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