Provider Demographics
NPI:1427365915
Name:JEWISH COMMUNITY CENTER OF STATEN ISLAND
Entity Type:Organization
Organization Name:JEWISH COMMUNITY CENTER OF STATEN ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTTENPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-475-5240
Mailing Address - Street 1:1466 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7027
Mailing Address - Country:US
Mailing Address - Phone:718-475-5240
Mailing Address - Fax:718-475-5206
Practice Address - Street 1:1466 MANOR RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7027
Practice Address - Country:US
Practice Address - Phone:718-475-5240
Practice Address - Fax:718-475-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care