Provider Demographics
NPI:1104027952
Name:INCARNATION CHILDREN'S CENTER
Entity Type:Organization
Organization Name:INCARNATION CHILDREN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-633-4710
Mailing Address - Street 1:142 AUDUBON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2102
Mailing Address - Country:US
Mailing Address - Phone:212-928-2590
Mailing Address - Fax:212-928-1500
Practice Address - Street 1:142 AUDUBON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2102
Practice Address - Country:US
Practice Address - Phone:212-928-2590
Practice Address - Fax:212-928-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002357N3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02072580Medicaid
NY335822Medicare ID - Type Unspecified