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General NPI Number Information
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NPI Number | 1023486842
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Entity Type | Organization
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Legal Business Name | TABULA ROSA
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 27 ROME AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10304-4317
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Country | US
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Telephone | 347-782-1329
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Fax |
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Provider Business Mailing Address
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Address Line | 27 ROME AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10304-4317
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Country | US
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Telephone | 347-782-1329
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRYSTYNA SHYMKO
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Credential | MS.SP.ED
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Telephone | 347-782-1329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 1361084
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License Number State | NY
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