1093912685 NPI number — SPECIAL NEEDS PROGRAM, INC

Table of content: (NPI 1093912685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093912685 NPI number — SPECIAL NEEDS PROGRAM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIAL NEEDS PROGRAM, 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:
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:
1093912685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 ROUTE 66
Provider Second Line Business Mailing Address:
P.O. BOX 349
Provider Business Mailing Address City Name:
GHENT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-822-1054
Provider Business Mailing Address Fax Number:
518-822-0739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1351 ROUTE 66
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GHENT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-822-1054
Provider Business Practice Location Address Fax Number:
518-822-0739
Provider Enumeration Date:
06/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HIME
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
MEROL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
518-822-1054

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: 02250008 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02648286 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02003249 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02597597 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02701320 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02587364 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00979800 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02111080 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01825992 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02363495 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02587373 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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