1013165315 NPI number — THE CHILD CENTER OF NY

Table of content: (NPI 1013165315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013165315 NPI number — THE CHILD CENTER OF NY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHILD CENTER OF NY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MS 8
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013165315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6002 QUEENS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11377-4973
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-651-7770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10835 157TH ST
Provider Second Line Business Practice Location Address:
ROOM 121 D
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11433-2744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-659-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COPPOLA
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
718-651-7770

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  6734122J , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00244371 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: WV0071 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7403085 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".