| Province Therapeutics, Llc | |
|
11835 Queens Blvd Suite 400 Forest Hills NY 11375-7200 | |
| (631) 827-9189 | |
| Not Available |
| Full Name | Province Therapeutics, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11835 Queens Blvd, Forest Hills, New York |
| Authorized Official Name and Position | Ashley E Patrick (OWNER) |
| Authorized Official Contact | 6318279189 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Province Therapeutics, Llc 11835 Queens Blvd Suite 400 Forest Hills NY 11375-7200 Ph: () - | Province Therapeutics, Llc 11835 Queens Blvd Suite 400 Forest Hills NY 11375-7200 Ph: (631) 827-9189 |
| NPI Number | 1801288568 |
|---|---|
| Provider Enumeration Date | 03/04/2015 |
| Last Update Date | 03/23/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801288568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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