Healthcare Provider Details

I. General information

NPI: 1760752505
Provider Name (Legal Business Name): SEWANHAKA HIGH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 TULIP AVE
FLORAL PARK NY
11001-3254
US

IV. Provider business mailing address

500 TULIP AVE
FLORAL PARK NY
11001-3254
US

V. Phone/Fax

Practice location:
  • Phone: 516-488-9652
  • Fax: 516-394-2697
Mailing address:
  • Phone: 516-488-9652
  • Fax: 516-394-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number00077061
License Number StateNY

VIII. Authorized Official

Name: ALAISA GRUDZINSKI
Title or Position: SCHOOL SOCIAL WORKER
Credential: LCSW
Phone: 516-488-9652