Provider Demographics
| NPI: | 1205852753 |
|---|---|
| Name: | EASTER SEALS NEW YORK, INC |
| Entity Type: | Organization |
| Organization Name: | EASTER SEALS NEW YORK, INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | KAREN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | WEGMANN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 212-727-4214 |
| Mailing Address - Street 1: | 633 THIRD AVE |
| Mailing Address - Street 2: | 6TH FLOOR |
| Mailing Address - City: | NEW YORK |
| Mailing Address - State: | NY |
| Mailing Address - Zip Code: | 10017 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 212-727-4200 |
| Mailing Address - Fax: | 212-727-4374 |
| Practice Address - Street 1: | 103 WHITE SPRUCE BLVD |
| Practice Address - Street 2: | |
| Practice Address - City: | ROCHESTER |
| Practice Address - State: | NY |
| Practice Address - Zip Code: | 14623-1610 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 585-292-5830 |
| Practice Address - Fax: | 585-292-5847 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | FEDCAP REHABILITATION SERVICES, INC. |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-07-15 |
| Last Update Date: | 2016-03-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YM0800X, 103T00000X, 207R00000X, 208000000X, 2084P0804X, 225100000X, 225X00000X, 235Z00000X, 251B00000X, 252Y00000X, 363LP0808X | ||
| NY | 2701234R | 261QD1600X, 261QM1300X |
| NY | 7773002A | 261QM0850X, 261QM0855X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | Group - Multi-Specialty | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NY | 02324418 | Medicaid | |
| NY | AA1460 | Medicare UPIN | |
| NY | 02324418 | Medicaid | |
| NY | 334532 | Medicare Oscar/Certification |
