Healthcare Provider Details

I. General information

NPI: 1780334722
Provider Name (Legal Business Name): BLACK OPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 CASTLETON AVE
STATEN ISLAND NY
10310-1702
US

IV. Provider business mailing address

1190 CASTLETON AVE
STATEN ISLAND NY
10310-1702
US

V. Phone/Fax

Practice location:
  • Phone: 917-589-3819
  • Fax:
Mailing address:
  • Phone: 917-589-3819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID NASEF
Title or Position: CEO
Credential: LSMW
Phone: 917-589-3819