Healthcare Provider Details

I. General information

NPI: 1407678477
Provider Name (Legal Business Name): A FRIENDLY FACE AKADEMY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 RICHMOND AVE STE 5
STATEN ISLAND NY
10314-3923
US

IV. Provider business mailing address

1887 RICHMOND AVE STE 5
STATEN ISLAND NY
10314-3923
US

V. Phone/Fax

Practice location:
  • Phone: 718-880-7000
  • Fax: 877-673-1774
Mailing address:
  • Phone: 718-880-7000
  • Fax: 877-673-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: OKSANA KOBRYN
Title or Position: BILLING MANAGER
Credential:
Phone: 718-973-0857