1295808020 NPI number — ICD INTERNATIONAL CENTER FOR THE DISABLED

Table of content: (NPI 1295808020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295808020 NPI number — ICD INTERNATIONAL CENTER FOR THE DISABLED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ICD INTERNATIONAL CENTER FOR THE DISABLED
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:
Provider Other Organization Name Type Code:
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:
1295808020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 E 24TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10010-4019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-585-6000
Provider Business Mailing Address Fax Number:
212-585-6262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 E 24TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-585-6000
Provider Business Practice Location Address Fax Number:
212-585-6262
Provider Enumeration Date:
11/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HALPERT
Authorized Official First Name:
LES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO AND PRESIDENT
Authorized Official Telephone Number:
212-585-6009

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  70022112R , 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: 00244413 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB5292 . This is a "RAILROAD RETIREMENT BD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040816000080 . This is a "FIDELIS HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58P0081 . This is a "NY HOSPITAL CHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A31902 . This is a "PERFORMAX-MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".