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General NPI Number Information
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NPI Number | 1942842232
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Entity Type | Organization
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Legal Business Name | DUNDERTY ENTERPRISE LLC.
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 119 THOMAS ST
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City | BRENTWOOD
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State | NY
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Zip | 11717-1218
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Country | US
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Telephone | 770-713-9158
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Fax |
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Provider Business Mailing Address
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Address Line | 119 THOMAS ST
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City | BRENTWOOD
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State | NY
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Zip | 11717-1218
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Country | US
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Telephone | 770-713-9158
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. GERALD J JORDAN
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Credential | MS
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Telephone | 770-713-9158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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