Organization
CORIZON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NICOLE CAMPBELL (HUMAN RESOURCE SPECIALIST)
(347) 774-7295
Entity
Organization
Contact information
Practice address
4904 19TH AVE, ASTORIA, NY 11105-1002
(347) 774-7295
Mailing address
49-04 19 AVE, ASTORIA, NY 11105
(347) 774-7295
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
011517-1
NY
Other
Enumeration date
11/26/2014
Last updated
11/26/2014
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