Provider Demographics
NPI:1093915993
Name:DORIS SCROZZO
Entity Type:Organization
Organization Name:DORIS SCROZZO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTA
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCROZZO
Authorized Official - Suffix:
Authorized Official - Credentials:OTA
Authorized Official - Phone:718-417-7118
Mailing Address - Street 1:7030 67TH ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6661
Mailing Address - Country:US
Mailing Address - Phone:718-417-7118
Mailing Address - Fax:
Practice Address - Street 1:70-38 67TH STREET
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-417-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004291320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities