Individual
CHARLOTTE BANILIVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15 MAPLE GROVE ST, GREAT NECK, NY 11023-1214
(516) 417-1341
Mailing address
15 MAPLE GROVE ST, GREAT NECK, NY 11023-1214
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1721264231
NY
Other
Enumeration date
07/20/2023
Last updated
07/20/2023
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