Healthcare Provider Details

I. General information

NPI: 1467828145
Provider Name (Legal Business Name): KSCHWETZ PROFESSIONAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 JERICHO TPKE SUITE 364
GARDEN CITY PARK NY
11040-4710
US

IV. Provider business mailing address

2417 JERICHO TPKE SUITE 364
GARDEN CITY PARK NY
11040-4710
US

V. Phone/Fax

Practice location:
  • Phone: 917-564-4309
  • Fax:
Mailing address:
  • Phone: 917-564-4309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KERRYANN M SCHWETZ
Title or Position: EARLY INTERVENTION
Credential: MSED, ABA
Phone: 917-564-4309