Provider Demographics
NPI:1285628552
Name:JULIA DYCKMAN ANDRUS MEMORIAL, INC.
Entity Type:Organization
Organization Name:JULIA DYCKMAN ANDRUS MEMORIAL, INC.
Other - Org Name:ANDRUS CHILDRENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEL PILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-965-3700
Mailing Address - Street 1:1156 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1108
Mailing Address - Country:US
Mailing Address - Phone:914-965-3700
Mailing Address - Fax:914-965-3883
Practice Address - Street 1:19 GREENRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1201
Practice Address - Country:US
Practice Address - Phone:914-949-7680
Practice Address - Fax:914-997-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7257001A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940Medicaid
10363OtherHUDSON HEALTH PLAN ID
NY050309000005OtherINTEGRA FIDELIS
322149OtherAFFINITY ID
NY3191813OtherGHI
NY00355940Medicaid