Organization
PROVINCE THERAPEUTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY E PATRICK (OWNER)
(631) 827-9189
Entity
Organization
Contact information
Practice address
11835 QUEENS BLVD, SUITE 400, FOREST HILLS, NY 11375-7200
(631) 827-9189
Mailing address
11835 QUEENS BLVD, SUITE 400, FOREST HILLS, NY 11375-7200
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/04/2015
Last updated
03/23/2017
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