| Formation Health Services Llc | |
|
8 Defeo Court Deer Park NY 11729 | |
| (631) 942-5429 | |
| Not Available |
| Full Name | Formation Health Services Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 8 Defeo Court, Deer Park, New York |
| Authorized Official Name and Position | Meesha Chan (MEMBER) |
| Authorized Official Contact | 6319425429 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Formation Health Services Llc 8 Defeo Court Deer Park NY 11729 Ph: (631) 942-5429 | Formation Health Services Llc 8 Defeo Court Deer Park NY 11729 Ph: (631) 942-5429 |
| NPI Number | 1881434561 |
|---|---|
| Provider Enumeration Date | 05/29/2024 |
| Last Update Date | 05/29/2024 |
| Certification Date | 05/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881434561 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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