Provider Demographics
NPI:1386626307
Name:HELEN KELLER SERVICES FOR THE BLIND
Entity Type:Organization
Organization Name:HELEN KELLER SERVICES FOR THE BLIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:516-485-1234
Mailing Address - Street 1:57 WILLOUGHBY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5290
Mailing Address - Country:US
Mailing Address - Phone:718-522-2122
Mailing Address - Fax:718-935-9463
Practice Address - Street 1:57 WILLOUGHBY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5290
Practice Address - Country:US
Practice Address - Phone:718-522-2122
Practice Address - Fax:718-935-9463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001202R152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243009Medicaid
NY00243009Medicaid