Individual
TED FORTUNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
40 ELMONT RD, ELMONT, NY 11003-1603
(347) 542-5644
Mailing address
14202 20TH AVE, FLUSHING, NY 11351-3000
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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