Provider Demographics
NPI:1730124025
Name:THE CHILDREN'S AID SOCIETY
Entity Type:Organization
Organization Name:THE CHILDREN'S AID SOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRITSOVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-571-9673
Mailing Address - Street 1:117 W 124TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4920
Mailing Address - Country:US
Mailing Address - Phone:203-571-9673
Mailing Address - Fax:212-682-2613
Practice Address - Street 1:910 EAST 172ND STREET
Practice Address - Street 2:BRONX FAMILY CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460
Practice Address - Country:US
Practice Address - Phone:347-767-2221
Practice Address - Fax:718-328-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QD0000X, 261QM0801X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245423Medicaid