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NPI Code Detail

MEDICARE: THE CHILD CENTER OF NY, INC.

MEDICARE: THE CHILD CENTER OF NY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0855XAdolescent and Children Mental Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27403085OTHERNYGHI
3WV0071OTHERNYBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1235288333
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE CHILD CENTER OF NY, INC.
Provider Business Mailing Address
First Line : 6002 QUEENS BLVD
Second Line : LOWER LEVEL
City : WOODSIDE
State : NY
Zip : 11377-4973
Country : US
Telephone Number : 718-651-7770
Fax Number : 718-651-5029
Provider Business Practice Location Address
First Line : 11515 SUTPHIN BLVD
Second Line :
City : JAMAICA
State : NY
Zip : 11434-1020
Country : US
Telephone Number : 718-659-4000
Fax Number : 718-659-1405
Authorized Official
Title or Position : DIRECTOR OF BILLING
Name : MS. JEAN M COPPOLA
Credential :
Telephone Number : 718-651-7770
Provider Enumeration Date : 01/09/2007
Last Update Date : 12/19/2013

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Directions to “THE CHILD CENTER OF NY, INC. ” Practice Location

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