Provider Demographics
NPI:1679648604
Name:FEDERATION OF ORGANIZATIONS FOR THE NY STATE MENTALLY DISABLED INC
Entity Type:Organization
Organization Name:FEDERATION OF ORGANIZATIONS FOR THE NY STATE MENTALLY DISABLED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:631-669-5355
Mailing Address - Street 1:1 FARMINGDALE ROAD
Mailing Address - Street 2:ROUTE 109
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704
Mailing Address - Country:US
Mailing Address - Phone:631-669-5355
Mailing Address - Fax:631-669-1114
Practice Address - Street 1:111 BEAVER DAM ROAD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11719
Practice Address - Country:US
Practice Address - Phone:631-286-2354
Practice Address - Fax:631-286-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02155122251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02155122Medicaid