| Path 2 Potential, Llc | |
|
5812 Queens Blvd 5o Woodside NY 11377-7765 | |
| (917) 270-6865 | |
| Not Available |
| Full Name | Path 2 Potential, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5812 Queens Blvd, Woodside, New York |
| Authorized Official Name and Position | Jason Lantier (CEO) |
| Authorized Official Contact | 9172706865 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Path 2 Potential, Llc 5812 Queens Blvd 5o Woodside NY 11377-7765 Ph: (917) 270-6865 | Path 2 Potential, Llc 5812 Queens Blvd 5o Woodside NY 11377-7765 Ph: (917) 270-6865 |
| NPI Number | 1437509106 |
|---|---|
| Provider Enumeration Date | 06/14/2016 |
| Last Update Date | 06/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437509106 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 000710 (New York) | Primary |
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