Organization
CLINTON HIGH SCHOOL
Active
Other names
School Health Program
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES BROCKET (ADMINISTRATOR)
(718) 920-4167
Entity
Organization
Contact information
Practice address
100 W MOSHOLU PKWY S, BRONX, NY 10468-1001
(718) 696-4071
Mailing address
PO BOX 4156, CHURCH STREET STATION, NEW YORK, NY 10261-4156
(718) 920-4649
(718) 515-5419
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
12/20/2007
Last updated
12/20/2007
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