Provider Demographics
NPI:1649442229
Name:NEW YORK FOUNDLING
Entity type:Organization
Organization Name:NEW YORK FOUNDLING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOJICA
Authorized Official - Suffix:
Authorized Official - Credentials:CBCS
Authorized Official - Phone:917-485-7291
Mailing Address - Street 1:590 AVENUE OF THE AMERICAS FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2022
Mailing Address - Country:US
Mailing Address - Phone:917-485-7291
Mailing Address - Fax:917-485-7590
Practice Address - Street 1:109 E 115TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1186
Practice Address - Country:US
Practice Address - Phone:917-485-7280
Practice Address - Fax:718-772-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
NY070311541261QD1600X
NY6396001A261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02800457Medicaid
NY1649442229Medicare PIN