Provider Demographics
NPI:1245400217
Name:THE CHILD CENTER OF NY
Entity Type:Organization
Organization Name:THE CHILD CENTER OF NY
Other - Org Name:EARLY INTERVENTION PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
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 1:14015 SANFORD AVE
Mailing Address - Street 2:2ND FLOOR (140-15B)
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2557
Mailing Address - Country:US
Mailing Address - Phone:718-539-2500
Mailing Address - Fax:718-358-5265
Practice Address - Street 1:14015 SANFORD AVE
Practice Address - Street 2:2ND FLOOR (140-15B)
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2557
Practice Address - Country:US
Practice Address - Phone:718-539-2500
Practice Address - Fax:718-358-5265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
66800OtherEI PROVIDER #