Provider Demographics
NPI:1114092053
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 ROAD
Mailing Address - Street 2:ROUTE 109
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704
Mailing Address - Country:US
Mailing Address - Phone:631-669-5355
Mailing Address - Fax:631-669-1114
Practice Address - Street 1:11 FARMINGDALE ROAD ROUTE 109
Practice Address - Street 2:11
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704
Practice Address - Country:US
Practice Address - Phone:631-321-8229
Practice Address - Fax:631-669-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02716952Medicaid