Individual
MERCEDES BAZAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
669 CASTLETON AVE, STATEN ISLAND, NY 10301-2028
(718) 354-5502
Mailing address
669 CASTLETON AVE, STATEN ISLAND, NY 10301-2028
(718) 354-5502
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
04/27/2022
Last updated
04/27/2022
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