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General NPI Number Information
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NPI Number | 1376407783
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Entity Type | Organization
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Legal Business Name | WILLOW PARK ACADEMY LLC
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 131 LAWN AVENUE UNIT D4
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City | STAMFORD
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State | CT
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Zip | 06902
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Country | US
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Telephone | 203-244-7438
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Fax |
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Provider Business Mailing Address
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Address Line | 4 FARMWOODS LN
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City | GLEN HEAD
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State | NY
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Zip | 11545-2730
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Country | US
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Telephone | 203-244-7438
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | OWAIS IQBAL
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Credential |
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Telephone | 516-474-8408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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