Provider Demographics
NPI:1073706032
Name:FEDERATION OF ORGANIZATIONS FOR THE NY STATE MENTALLY DISABLED INC
Entity Type:Organization
Organization Name:FEDERATION OF ORGANIZATIONS FOR THE NY STATE MENTALLY DISABLED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-669-5355
Mailing Address - Street 1:1 FARMINGDALE
Mailing Address - Street 2:ROUTE 109
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6545
Mailing Address - Country:US
Mailing Address - Phone:631-669-5355
Mailing Address - Fax:631-669-1114
Practice Address - Street 1:456 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1586
Practice Address - Country:US
Practice Address - Phone:631-447-6460
Practice Address - Fax:631-289-7098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03007701251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03007701Medicaid
NYWEY681Medicare PIN