Healthcare Provider Details

I. General information

NPI: 1174912307
Provider Name (Legal Business Name): MALVERNE CENTER FOR PLAY AND DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CHURCH ST
MALVERNE NY
11565-1726
US

IV. Provider business mailing address

77 CHURCH ST
MALVERNE NY
11565-1726
US

V. Phone/Fax

Practice location:
  • Phone: 516-495-4898
  • Fax: 516-513-1099
Mailing address:
  • Phone: 516-495-4898
  • Fax: 516-513-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number013301-1
License Number StateNY

VIII. Authorized Official

Name: MS. EMILIA SOLINTO
Title or Position: DIRECTOR
Credential: OTD, OTR/L
Phone: 516-495-4898