Healthcare Provider Details

I. General information

NPI: 1225389869
Provider Name (Legal Business Name): CHILDREN'S CORNER DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2012
Last Update Date: 09/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17319 69TH AVE
FLUSHING NY
11365-3403
US

IV. Provider business mailing address

17319 69TH AVE
FLUSHING NY
11365-3403
US

V. Phone/Fax

Practice location:
  • Phone: 718-358-8926
  • Fax: 718-358-8926
Mailing address:
  • Phone: 718-358-8926
  • Fax: 718-358-8926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012970
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number016494
License Number StateNY

VIII. Authorized Official

Name: MR. SETH L. ZUCKER
Title or Position: HEAD ADMINISTRATOR
Credential:
Phone: 718-358-8926