Provider Demographics
NPI:1417495714
Name:THE CARTER BURDEN CENTER FOR THE AGING
Entity Type:Organization
Organization Name:THE CARTER BURDEN CENTER FOR THE AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-897-7400
Mailing Address - Street 1:1484 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2304
Mailing Address - Country:US
Mailing Address - Phone:212-879-7400
Mailing Address - Fax:212-979-9864
Practice Address - Street 1:301 E 99TH ST
Practice Address - Street 2:METRO E. 99TH ST HYBRID SOCIAL MODEL ADULT DAY PROGRAM
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7469
Practice Address - Country:US
Practice Address - Phone:646-504-5900
Practice Address - Fax:212-427-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNAOtherSOCIAL ADULT DAY PROGRAM