Provider Demographics
NPI:1124379482
Name:CENTER FOR DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:CENTER FOR DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING SUPERVISIOR CHILDRENS SERVI
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SANTASIERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:516-921-7650
Mailing Address - Street 1:72 S WOODS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1024
Mailing Address - Country:US
Mailing Address - Phone:516-921-7650
Mailing Address - Fax:516-921-2698
Practice Address - Street 1:72 S WOODS RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1024
Practice Address - Country:US
Practice Address - Phone:516-921-7650
Practice Address - Fax:516-921-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300626-1251C00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care