Individual
ANTONIA MAZARAKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2328 36TH ST, ASTORIA, NY 11105-2213
(646) 662-6583
Mailing address
2328 36TH ST, ASTORIA, NY 11105-2213
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
015049
NY
Other
Enumeration date
09/24/2008
Last updated
09/24/2008
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