1174852123 NPI number — MARTIN DE PORRES SCHOOL FOR EXCEPTIONAL CHILDREN, INC.

Table of content: (NPI 1174852123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174852123 NPI number — MARTIN DE PORRES SCHOOL FOR EXCEPTIONAL CHILDREN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN DE PORRES SCHOOL FOR EXCEPTIONAL CHILDREN, 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:
6
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:
1174852123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13625 218TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD GARDENS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11413-2226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
171-852-5341
Provider Business Mailing Address Fax Number:
171-852-5098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13625 218TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD GARDENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11413-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
171-852-5341
Provider Business Practice Location Address Fax Number:
171-285-2509
Provider Enumeration Date:
12/21/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DARNOWSKI
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
DIRECTOR: QA / COMPLIANCE
Authorized Official Telephone Number:
17185255649

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , 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)