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General NPI Number Information
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NPI Number | 1093991168
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Entity Type | Organization
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Legal Business Name | KINGSBAY YM-YWHA
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 3495 NOSTRAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11229-5131
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Country | US
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Telephone | 718-648-7703
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Fax | 718-648-0758
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Provider Business Mailing Address
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Address Line | 3495 NOSTRAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11229-5131
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Country | US
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Telephone | 718-648-7703
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Fax | 718-648-0758
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LEONARD PETLAKH
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Credential |
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Telephone | 718-648-7703
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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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