Provider Demographics
NPI:1821529322
Name:CIFUENTES CHILD DEVELOPMENT, CORP.
Entity Type:Organization
Organization Name:CIFUENTES CHILD DEVELOPMENT, CORP.
Other - Org Name:CIFUENTES ASSOCIATES, CORP.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SPECIAL EDUCATION PROVIDE
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIFUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MSE
Authorized Official - Phone:516-288-5012
Mailing Address - Street 1:9962 211TH PL
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1145
Mailing Address - Country:US
Mailing Address - Phone:516-288-5012
Mailing Address - Fax:718-217-5159
Practice Address - Street 1:9962 211TH PL
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-1145
Practice Address - Country:US
Practice Address - Phone:516-288-5012
Practice Address - Fax:718-217-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-26
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1076683162252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1306108667Medicaid
NY1821529322Medicaid