Provider Demographics
NPI:1457674921
Name:INTERNATIONAL CENTER FOR THE DISABLED
Entity Type:Organization
Organization Name:INTERNATIONAL CENTER FOR THE DISABLED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRCTOR OF CLINICAL DEPT.
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:212-585-6000
Mailing Address - Street 1:340 EAST 24TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:212-585-6000
Mailing Address - Fax:212-585-6262
Practice Address - Street 1:340 E 24TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4019
Practice Address - Country:US
Practice Address - Phone:212-585-6000
Practice Address - Fax:212-585-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003287-1251S00000X
NY12429251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health