Provider Demographics
NPI:1003961384
Name:GROWING ZONE THERAPEUTIC
Entity Type:Organization
Organization Name:GROWING ZONE THERAPEUTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GAMBINO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:631-242-0240
Mailing Address - Street 1:41 BAYBERRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2141
Mailing Address - Country:US
Mailing Address - Phone:631-242-0240
Mailing Address - Fax:
Practice Address - Street 1:41 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2141
Practice Address - Country:US
Practice Address - Phone:631-242-0240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110743045251B00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management