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General NPI Number Information
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NPI Number | 1841640638
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Entity Type | Organization
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Legal Business Name | SUNRISE DAY CAMP
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 75 COLONIAL SPRINGS RD
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City | WHEATLEY HEIGHTS
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State | NY
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Zip | 11798-1014
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Country | US
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Telephone | 631-920-6439
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Fax |
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Provider Business Mailing Address
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Address Line | 15 NEIL CT
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City | OCEANSIDE
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State | NY
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Zip | 11572-5815
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Country | US
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Telephone | 631-920-6439
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Fax |
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Authorized Official
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Title or Position | NURSE COORDINATOR
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Name | MRS. AVA DAWSON
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Credential | CPNP-PC
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Telephone | 347-371-0323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number | 704160
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License Number State | NY
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