Provider Demographics
NPI:1336312941
Name:ASSOCIATION FOR TECHNOLOGY DEPENDENT CHILDREN
Entity Type:Organization
Organization Name:ASSOCIATION FOR TECHNOLOGY DEPENDENT CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR AND FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:POLICASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-878-8900
Mailing Address - Street 1:15 CALICO TREE RD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2623
Mailing Address - Country:US
Mailing Address - Phone:631-878-8900
Mailing Address - Fax:631-878-8201
Practice Address - Street 1:15 CALICO TREE RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2623
Practice Address - Country:US
Practice Address - Phone:631-878-8900
Practice Address - Fax:631-878-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01569204Medicaid