1063884914 NPI number — YOUNG ADULT INSTITUTE, INC

Table of content: MS. CYNTHIA ANN THERRIEN COTA (NPI 1992035539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063884914 NPI number — YOUNG ADULT INSTITUTE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUNG ADULT INSTITUTE, 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:
YOUNG ADULT INSTITUTE, INC / FOUNTAIN AVE.
Provider Other Organization Name Type Code:
3
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:
1063884914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
460 W 34TH 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:
10001-2320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-273-6206
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
888 FOUNTAIN AVE
Provider Second Line Business Practice Location Address:
WING 214
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11239-5907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-273-6206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CONTOS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
212-273-6206

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6113102 . This is a "OPWDD OPERATING CERTIFICATE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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