Provider Demographics
NPI:1952676561
Name:IMOLLOY COLLEGE REBECCA CENTER
Entity Type:Organization
Organization Name:IMOLLOY COLLEGE REBECCA CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARPENTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-678-5000
Mailing Address - Street 1:1000 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11571-5002
Mailing Address - Country:US
Mailing Address - Phone:516-678-5000
Mailing Address - Fax:516-255-4823
Practice Address - Street 1:1000 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11571-5002
Practice Address - Country:US
Practice Address - Phone:516-678-5000
Practice Address - Fax:516-255-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015451261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities