Provider Demographics
NPI:1336354141
Name:CARL FENICHEL COMMUNITY SERVICES
Entity Type:Organization
Organization Name:CARL FENICHEL COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:POLIZOES
Authorized Official - Middle Name:
Authorized Official - Last Name:POLIZOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-856-4300
Mailing Address - Street 1:885 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4113
Mailing Address - Country:US
Mailing Address - Phone:718-856-4300
Mailing Address - Fax:718-856-4581
Practice Address - Street 1:885 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4113
Practice Address - Country:US
Practice Address - Phone:718-856-4300
Practice Address - Fax:718-856-4581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098311-1251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services