Organization
THE RE-CREATION BOUTIQUE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VIVIAN CATHERINE SCIACCA (PRESIDENT)
(718) 746-0312
Entity
Organization
Contact information
Practice address
15253 10TH AVE, SUITE 214, WHITESTONE, NY 11357-1216
(718) 746-0213
(718) 746-4696
Mailing address
15253 10TH AVE, SUITE 214, WHITESTONE, NY 11357-1216
(718) 746-0213
(718) 746-4696
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01481983
—
NY
Enumeration date
08/25/2006
Last updated
03/11/2009
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