Healthcare Provider Details

I. General information

NPI: 1760627723
Provider Name (Legal Business Name): BROOKVILLE CENTER FOR CHILDREN'S SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 WHEATLEY ROAD
BROOKVILLE NY
11545
US

IV. Provider business mailing address

189 WHEATLEY ROAD
BROOKVILLE NY
11545
US

V. Phone/Fax

Practice location:
  • Phone: 516-626-1000
  • Fax: 516-626-3308
Mailing address:
  • Phone: 516-626-1000
  • Fax: 516-622-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL W. MASCARI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 516-626-1000