Provider Demographics
NPI:1972968394
Name:CHILDREN'S SPEICALIZED HOSPITAL
Entity Type:Organization
Organization Name:CHILDREN'S SPEICALIZED HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L
Authorized Official - Phone:917-538-9275
Mailing Address - Street 1:5400 FIELDSTON RD
Mailing Address - Street 2:62F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5400 FIELDSTON RD
Practice Address - Street 2:62F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2541
Practice Address - Country:US
Practice Address - Phone:917-538-9275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00661900283XC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283XC2000XHospitalsRehabilitation HospitalChildren