Healthcare Provider Details

I. General information

NPI: 1720570187
Provider Name (Legal Business Name): A FRIENDLY FACE AKADEMY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
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

460 MIDLAND AVE
STATEN ISLAND NY
10306-5104
US

V. Phone/Fax

Practice location:
  • Phone: 718-698-1300
  • Fax:
Mailing address:
  • Phone: 718-667-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELLA GOLDIN
Title or Position: CFO
Credential:
Phone: 718-698-1300