1417495714 NPI number — THE CARTER BURDEN CENTER FOR THE AGING

Table of content: (NPI 1417495714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417495714 NPI number — THE CARTER BURDEN CENTER FOR THE AGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CARTER BURDEN CENTER FOR THE AGING
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:
1417495714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1484 1ST AVE
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:
10075-2304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-879-7400
Provider Business Mailing Address Fax Number:
212-979-9864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 E 99TH ST
Provider Second Line Business Practice Location Address:
METRO E. 99TH ST HYBRID SOCIAL MODEL ADULT DAY PROGRAM
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029-7469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-504-5900
Provider Business Practice Location Address Fax Number:
212-427-3219
Provider Enumeration Date:
02/07/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DIONNE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
212-897-7400

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NA . This is a "SOCIAL ADULT DAY PROGRAM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".