Provider Demographics
NPI:1013112358
Name:ICD INTERNATIONAL CENTER FOR THE DISABLED
Entity Type:Organization
Organization Name:ICD INTERNATIONAL CENTER FOR THE DISABLED
Other - Org Name:ICD MENTAL HEALTH CLINIC PS 146
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LES
Authorized Official - Middle Name:
Authorized Official - Last Name:HALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-585-6009
Mailing Address - Street 1:340 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4019
Mailing Address - Country:US
Mailing Address - Phone:212-585-6000
Mailing Address - Fax:212-585-6262
Practice Address - Street 1:421 E 106TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4846
Practice Address - Country:US
Practice Address - Phone:212-996-6127
Practice Address - Fax:212-828-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6704100B261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244413Medicaid
NY040816000080OtherFIDELIS CARE NEW YORK
NYA31902OtherPERFORMAX-MULTIPLAN
NY58P0081OtherNYPRESBY HEALTH PLAN
NY1054350OtherBEACON HEALTH STRATEGIES
NY58P0081OtherNYPRESBY HEALTH PLAN
NY=========OtherHIP BEHAVIORAL HEALTH