Healthcare Provider Details

I. General information

NPI: 1922251313
Provider Name (Legal Business Name): CENTER FOR SPECTRUM SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KUKUK LN
KINGSTON NY
12401-6943
US

IV. Provider business mailing address

70 KUKUK LN
KINGSTON NY
12401-6943
US

V. Phone/Fax

Practice location:
  • Phone: 845-336-2616
  • Fax:
Mailing address:
  • Phone: 845-336-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LEAH M SIUTA
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 845-336-2616