Provider Demographics
NPI:1851534036
Name:CENTRAL PARK THERAPY, INC.
Entity Type:Organization
Organization Name:CENTRAL PARK THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:631-549-6994
Mailing Address - Street 1:150 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4905
Mailing Address - Country:US
Mailing Address - Phone:631-549-6994
Mailing Address - Fax:631-549-7203
Practice Address - Street 1:150 BROADHOLLOW RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4905
Practice Address - Country:US
Practice Address - Phone:631-549-6994
Practice Address - Fax:631-549-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency