Provider Demographics
NPI:1679024210
Name:EASTER SEALS OF NY INC-KESSLER ICF B
Entity Type:Organization
Organization Name:EASTER SEALS OF NY INC-KESSLER ICF B
Other - Org Name:THE KESSLER CENTER OF EASTER SEALS NY
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-727-4214
Mailing Address - Street 1:633 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-6706
Mailing Address - Country:US
Mailing Address - Phone:212-727-4214
Mailing Address - Fax:212-727-4293
Practice Address - Street 1:304 DALEY BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-3848
Practice Address - Country:US
Practice Address - Phone:585-957-7206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDCAP REHABILITATION SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03378970Medicaid