Healthcare Provider Details

I. General information

NPI: 1235374448
Provider Name (Legal Business Name): FEDCAP REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011A WASHINGTON AVE
BRONX NY
10456-6628
US

IV. Provider business mailing address

633 3RD AVE FL 6
NEW YORK NY
10017-6733
US

V. Phone/Fax

Practice location:
  • Phone: 718-764-5127
  • Fax:
Mailing address:
  • Phone: 212-727-4227
  • Fax: 212-727-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6001L001
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number8805001A
License Number StateNY

VIII. Authorized Official

Name: MR. CHRISTINE MCMAHON
Title or Position: CEO
Credential: EXECUTIVE DIRECTOR
Phone: 212-727-4275