Provider Demographics
NPI:1003083767
Name:CARL FENICHEL COMMUNITY SERVICES
Entity Type:Organization
Organization Name:CARL FENICHEL COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-643-5300
Mailing Address - Street 1:30 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-8201
Mailing Address - Country:US
Mailing Address - Phone:718-643-5300
Mailing Address - Fax:718-237-2793
Practice Address - Street 1:30 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-8201
Practice Address - Country:US
Practice Address - Phone:718-643-5300
Practice Address - Fax:718-237-2793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01218533Medicaid