Provider Demographics
NPI:1235288333
Name:THE CHILD CENTER OF NY, INC.
Entity Type:Organization
Organization Name:THE CHILD CENTER OF NY, INC.
Other - Org Name:SOUTH JAMAICA CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-651-7770
Mailing Address - Street 1:6002 QUEENS BLVD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4973
Mailing Address - Country:US
Mailing Address - Phone:718-651-7770
Mailing Address - Fax:718-651-5029
Practice Address - Street 1:11515 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1020
Practice Address - Country:US
Practice Address - Phone:718-659-4000
Practice Address - Fax:718-659-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244371Medicaid
NY7403085OtherGHI
NYWV0071OtherBLUE CROSS BLUE SHIELD
NYWV0071OtherBLUE CROSS BLUE SHIELD