Provider Demographics
NPI:1326408469
Name:MARTIN DE PORRES SCHOOL FOR EXCEPTIONAL CHILDREN, INC.
Entity Type:Organization
Organization Name:MARTIN DE PORRES SCHOOL FOR EXCEPTIONAL CHILDREN, INC.
Other - Org Name:MARTIN DE PORRES SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CARLETON
Authorized Official - Last Name:DANA
Authorized Official - Suffix:
Authorized Official - Credentials:DSW
Authorized Official - Phone:516-502-2840
Mailing Address - Street 1:621 ELMONT RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4028
Mailing Address - Country:US
Mailing Address - Phone:516-502-2840
Mailing Address - Fax:516-502-2841
Practice Address - Street 1:621 ELMONT RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4028
Practice Address - Country:US
Practice Address - Phone:516-502-2840
Practice Address - Fax:516-502-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6455725253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency