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NPI Code Detail

MEDICARE: INTERBOROUGH DEVELOPMENTAL AND CONSULTATION CENTER, INC.

MEDICARE: INTERBOROUGH DEVELOPMENTAL AND CONSULTATION CENTER, 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
12084P0800XPsychiatry Physician
2104100000XSocial Worker
3251B00000XCase Management Agency6989100ANY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588611842
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERBOROUGH DEVELOPMENTAL AND CONSULTATION CENTER, INC.
Provider Business Mailing Address
First Line : 1623 KINGS HWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-1209
Country : US
Telephone Number : 718-375-1200
Fax Number : 718-382-3358
Provider Business Practice Location Address
First Line : 1623 KINGS HWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-1209
Country : US
Telephone Number : 718-375-1200
Fax Number : 718-382-3358
Authorized Official
Title or Position : CEO
Name : STEPHEN GERSTEN
Credential : PSY.D.
Telephone Number : 929-273-7601
Provider Enumeration Date : 05/30/2006
Last Update Date : 04/19/2021

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