Organization
BLACK ICE PRODUCTION
Active
Other names
BLACK ICE PRO
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDRE M GIBSON (MANGER)
(347) 240-8070
Entity
Organization
Contact information
Practice address
1001 EAST STREET, BROOKLYN, NY 11210
(347) 240-8070
Mailing address
1001 E 37TH ST, BROOKLYN, NY 11210-3431
13472408070
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
071465614
NY
284300000X
Special Hospital
—
—
Other
Enumeration date
02/23/2009
Last updated
02/23/2009
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