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General NPI Number Information
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NPI Number | 1215360615
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Entity Type | Organization
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Legal Business Name | GITY PRO GROUP
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 14934 121ST ST
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420-4019
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Country | US
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Telephone | 718-848-8742
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Fax |
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Provider Business Mailing Address
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Address Line | 14934 121ST STREET
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City | SOUTH OZONE PARK
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State | NY
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Zip | 11420
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Country | US
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Telephone | 718-848-8742
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. MICHAEL MARKAKIS
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Credential | D.O.
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Telephone | 718-769-2698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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