Organization
MENORAH PARK GROUP RESIDENTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONI COLE (OFFICE)
(315) 446-9111
Entity
Organization
Contact information
Practice address
12 JAMAR DRIVE, DEWITT, NY 13066
(315) 446-9111
Mailing address
12 JAMAR DR, FAYETTEVILLE, NY 13066-1619
(315) 446-9111
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
SPV46480
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03035921
—
NY
Enumeration date
03/18/2009
Last updated
03/18/2009
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