| Martin De Porres | |
|
621 Elmont Rd Elmont NY 11003-4028 | |
| (516) 502-2840 | |
| Not Available |
| Full Name | Martin De Porres |
|---|---|
| Speciality | Social Worker - School |
| Location | 621 Elmont Rd, Elmont, New York |
| Authorized Official Name and Position | Edward Dana (DIRECTOR OF RELATED SERVICES) |
| Authorized Official Contact | 5165022840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Martin De Porres 621 Elmont Rd Elmont NY 11003-4028 Ph: (516) 502-2840 | Martin De Porres 621 Elmont Rd Elmont NY 11003-4028 Ph: (516) 502-2840 |
| NPI Number | 1649580861 |
|---|---|
| Provider Enumeration Date | 10/21/2010 |
| Last Update Date | 10/21/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649580861 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041S0200X | Social Worker - School | 6455725 (New York) | Primary |
Martin De Porres Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 621 Elmont Road, Elmont, NY 10003 Phone: 516-502-2840 Fax: 516-502-2841 | |
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