Provider Demographics
NPI:1689102808
Name:CAREFIRST CDPAP, CORP.
Entity Type:Organization
Organization Name:CAREFIRST CDPAP, CORP.
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHADAEV
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:646-226-6831
Mailing Address - Street 1:40 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7206
Mailing Address - Country:US
Mailing Address - Phone:917-678-9087
Mailing Address - Fax:
Practice Address - Street 1:40 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-7206
Practice Address - Country:US
Practice Address - Phone:646-226-6831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04691609Medicaid