Healthcare Provider Details

I. General information

NPI: 1912150046
Provider Name (Legal Business Name): STORY PLACE PRESCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 POND VW SUITE 102A
CASTLETON NY
12033-9750
US

IV. Provider business mailing address

2500 POND VW SUITE 102A
CASTLETON NY
12033-9750
US

V. Phone/Fax

Practice location:
  • Phone: 518-477-6072
  • Fax: 518-477-6074
Mailing address:
  • Phone: 518-477-6072
  • Fax: 518-477-6074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number005266
License Number StateNY

VIII. Authorized Official

Name: MRS. CAROL H ALTWERGER
Title or Position: EXECUTIVE DIRECTOR
Credential: PHYSICAL THERAPIST
Phone: 518-477-6072