Provider Demographics
NPI:1295808020
Name:ICD INTERNATIONAL CENTER FOR THE DISABLED
Entity type:Organization
Organization Name:ICD INTERNATIONAL CENTER FOR THE DISABLED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
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 1:340 E 24TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4019
Practice Address - Country:US
Practice Address - Phone:212-585-6000
Practice Address - Fax:212-585-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70022112R261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244413Medicaid
NYDB5292OtherRAILROAD RETIREMENT BD
NY040816000080OtherFIDELIS HEALTHCARE
NY58P0081OtherNY HOSPITAL CHP
NYA31902OtherPERFORMAX-MULTIPLAN
NYW20561Medicare ID - Type UnspecifiedPART B PHYS MED