Healthcare Provider Details

I. General information

NPI: 1821529322
Provider Name (Legal Business Name): CIFUENTES CHILD DEVELOPMENT, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9962 211TH PL
QUEENS VILLAGE NY
11429-1145
US

IV. Provider business mailing address

9962 211TH PL
QUEENS VILLAGE NY
11429-1145
US

V. Phone/Fax

Practice location:
  • Phone: 516-288-5012
  • Fax: 718-217-5159
Mailing address:
  • Phone: 516-288-5012
  • Fax: 718-217-5159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1076683162
License Number StateNY

VIII. Authorized Official

Name: SANDRA CIFUENTES
Title or Position: SPECIAL EDUCATION PROVIDE
Credential: MSE
Phone: 516-288-5012