1639228596 NPI number — THE CHILD CENTER OF NY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639228596 NPI number — THE CHILD CENTER OF NY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHILD CENTER OF NY, INC.
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:
BLENDED CASE MANAGEMENT
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:
1639228596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2013
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:
LOWER LEVEL
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:
718-651-5029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6002 QUEENS BLVD
Provider Second Line Business Practice Location Address:
THE IRA MEYER CHILDREN'S CENTER
Provider Business Practice Location Address City Name:
WOODSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11377-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-943-3470
Provider Business Practice Location Address Fax Number:
718-651-7254
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02189724 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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