Healthcare Provider Details

I. General information

NPI: 1518181197
Provider Name (Legal Business Name): INNOVATIVE APPROACH FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12360 83RD AVE PHJ
KEW GARDENS NY
11415-3452
US

IV. Provider business mailing address

12360 83RD AVE PHJ
KEW GARDENS NY
11415-3452
US

V. Phone/Fax

Practice location:
  • Phone: 347-756-2455
  • Fax: 347-475-0827
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DEMETRIUS FINCHER
Title or Position: CEO
Credential:
Phone: 347-756-2455