Provider Demographics
NPI:1134513955
Name:NEW SQUARE COMMUNITY IMPROVEMENT COUNCIL, INC.
Entity Type:Organization
Organization Name:NEW SQUARE COMMUNITY IMPROVEMENT COUNCIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-354-4100
Mailing Address - Street 1:766 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1985
Mailing Address - Country:US
Mailing Address - Phone:845-354-4100
Mailing Address - Fax:845-354-0334
Practice Address - Street 1:766 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW SQUARE
Practice Address - State:NY
Practice Address - Zip Code:10977-1985
Practice Address - Country:US
Practice Address - Phone:845-354-4100
Practice Address - Fax:845-354-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency