Provider Demographics
NPI:1427224641
Name:FEGS BRONX DEV DAY TRT2
Entity Type:Organization
Organization Name:FEGS BRONX DEV DAY TRT2
Other - Org Name:FEGS BRONX DDT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WAIZER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-366-8024
Mailing Address - Street 1:315 HUDSON ST
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-1009
Mailing Address - Country:US
Mailing Address - Phone:212-366-8129
Mailing Address - Fax:
Practice Address - Street 1:2432 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5204
Practice Address - Country:US
Practice Address - Phone:718-220-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00745042Medicaid