Healthcare Provider Details

I. General information

NPI: 1649043092
Provider Name (Legal Business Name): MAKING HEADWAY FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 KING ST
CHAPPAQUA NY
10514-3460
US

IV. Provider business mailing address

115 KING ST
CHAPPAQUA NY
10514-3460
US

V. Phone/Fax

Practice location:
  • Phone: 914-238-8384
  • Fax: 914-238-1693
Mailing address:
  • Phone: 914-238-8384
  • Fax: 914-238-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LIPKA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 914-238-8384