Provider Demographics
NPI:1457444234
Name:GODDARD RIVERSIDE COMMUNITY CENTER
Entity Type:Organization
Organization Name:GODDARD RIVERSIDE COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FISCAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-873-6600
Mailing Address - Street 1:593 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1904
Mailing Address - Country:US
Mailing Address - Phone:212-873-6600
Mailing Address - Fax:212-595-6498
Practice Address - Street 1:965 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3140
Practice Address - Country:US
Practice Address - Phone:212-531-2727
Practice Address - Fax:212-531-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7296471A251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable