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General NPI Number Information
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NPI Number | 1740678069
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Entity Type | Organization
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Legal Business Name | ICS CARE
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 435 BERTRAM AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-5832
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Country | US
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Telephone | 718-608-5847
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Fax |
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Provider Business Mailing Address
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Address Line | 435 BERTRAM AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10312-5832
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Country | US
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Telephone | 718-608-5847
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | MS. IVANA SANTANGELO
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Credential | M.S.ED.
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Telephone | 718-698-5847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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