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General NPI Number Information
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NPI Number | 1033865027
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Entity Type | Organization
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Legal Business Name | ISLAND SOCIAL DAY CENTER INC
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 5515 VAN CLEEF ST
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City | CORONA
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State | NY
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Zip | 11368-3907
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Country | US
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Telephone | 929-575-0958
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Fax |
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Provider Business Mailing Address
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Address Line | 9906 58TH AVE APT 1A
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City | CORONA
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State | NY
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Zip | 11368-3701
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Country | US
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Telephone | 929-575-0958
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JINLAN LU
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Credential | MS
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Telephone | 929-575-0958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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