Healthcare Provider Details

I. General information

NPI: 1730124025
Provider Name (Legal Business Name): THE CHILDREN'S AID SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 EAST 172ND STREET BRONX FAMILY CENTER
BRONX NY
10460
US

IV. Provider business mailing address

117 W 124TH ST FL 6
NEW YORK NY
10027-4920
US

V. Phone/Fax

Practice location:
  • Phone: 347-767-2221
  • Fax: 718-328-7494
Mailing address:
  • Phone: 212-949-4800
  • Fax: 212-986-9635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNY

VIII. Authorized Official

Name: JUSTIN KOPA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 929-697-2947