MEDICARE: WILLOW PARK ACADEMY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1376407783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW PARK ACADEMY LLC

Provider Business Mailing Address
First Line	:	4 FARMWOODS LN
Second Line	:
City	:	GLEN HEAD
State	:	NY
Zip	:	11545-2730
Country	:	US
Telephone Number	:	203-244-7438
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 LAWN AVENUE
Second Line	:	UNIT D4
City	:	STAMFORD
State	:	CT
Zip	:	06902
Country	:	US
Telephone Number	:	203-244-7438
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OWAIS IQBAL
Credential	:
Telephone Number	:	516-474-8408

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

Similar Medicare Providers

1316035298 — DEMETRIA TRINNETTE MCKENZIE MSW
Practice Location Address:

60 PALMERS HILL ROAD
STAMFORD, CT
06902

Practice Phone: 203-324-3167
Practice Fax: 203-358-2327

1508539735 — ANTHONY CHAO CRNA
Practice Location Address:

1 HOSPITAL PLZ
STAMFORD, CT
06902-3602

Practice Phone: 203-276-1000
Practice Fax:

1982341012 — SHEHRYAR NAJEEB MD
Practice Location Address:

1 HOSPITAL PLZ
STAMFORD, CT
06902-3602

Practice Phone: 203-276-7298
Practice Fax: 203-276-4842

1982188835 — NINA GILBERT PSYCHOTHERAPY, LLC
Practice Location Address:

14 DORA ST APT 4
STAMFORD, CT
06902-9407

Practice Phone: 704-281-3411
Practice Fax:

1407593528 — MARINA MIRKOVIC MD
Practice Location Address:

1 HOSPITAL PLZ
STAMFORD, CT
06902-3602

Practice Phone: 203-276-7147
Practice Fax:

1851255277 — R..A. CALDWELL CO. INC
Practice Location Address:

474 W MAIN ST
STAMFORD, CT
06902-5598

Practice Phone: 203-348-0174
Practice Fax: 203-348-7004

Directions to “WILLOW PARK ACADEMY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.