Healthcare Provider Details

I. General information

NPI: 1376839613
Provider Name (Legal Business Name): ACCESS7 SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 JERICHO TPKE
COMMACK NY
11725-2850
US

IV. Provider business mailing address

6080 JERICHO TPKE
COMMACK NY
11725-2850
US

V. Phone/Fax

Practice location:
  • Phone: 631-864-7770
  • Fax: 631-864-7773
Mailing address:
  • Phone: 631-864-7770
  • Fax: 631-864-7773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3602
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number065635-1
License Number StateNY

VIII. Authorized Official

Name: MRS. JO DISTEFANO
Title or Position: PRESIDENT
Credential:
Phone: 631-864-7770