Provider Demographics
NPI:1003115361
Name:FABRICK CORP.
Entity Type:Organization
Organization Name:FABRICK CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FREDA
Authorized Official - Middle Name:SAJOUS
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:516-295-0013
Mailing Address - Street 1:6 CLOVERFIELD RD N
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2404
Mailing Address - Country:US
Mailing Address - Phone:516-295-0013
Mailing Address - Fax:516-295-0013
Practice Address - Street 1:6 CLOVERFIELD RD N
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2404
Practice Address - Country:US
Practice Address - Phone:516-295-0013
Practice Address - Fax:516-295-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0048911251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services