Healthcare Provider Details

I. General information

NPI: 1033865027
Provider Name (Legal Business Name): ISLAND SOCIAL DAY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 VAN CLEEF ST
CORONA NY
11368-3907
US

IV. Provider business mailing address

9906 58TH AVE APT 1A
CORONA NY
11368-3701
US

V. Phone/Fax

Practice location:
  • Phone: 929-575-0958
  • Fax:
Mailing address:
  • Phone: 929-575-0958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JINLAN LU
Title or Position: PRESIDENT
Credential: MS
Phone: 929-575-0958