Healthcare Provider Details

I. General information

NPI: 1679745913
Provider Name (Legal Business Name): TERAPRO. CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 SCHLEIGEL BLVD
AMITYVILLE NY
11701-1345
US

IV. Provider business mailing address

PO BOX 30088
BROOKLYN NY
11203-0088
US

V. Phone/Fax

Practice location:
  • Phone: 718-404-2185
  • Fax:
Mailing address:
  • Phone: 718-404-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number0089371
License Number StateNY

VIII. Authorized Official

Name: MR. CARLOS ANTONIO BENT
Title or Position: SENIOR OCCUPATIONAL THERAPIST
Credential:
Phone: 718-249-5884