Healthcare Provider Details

I. General information

NPI: 1114329786
Provider Name (Legal Business Name): ATLAS FOUNDATION FOR AUTISM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 W 29TH ST 3RD FLOOR
NEW YORK NY
10001-5271
US

IV. Provider business mailing address

252 W 29TH ST 3RD FLOOR
NEW YORK NY
10001-5271
US

V. Phone/Fax

Practice location:
  • Phone: 212-256-0846
  • Fax:
Mailing address:
  • Phone: 212-256-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA FRIEDMAN
Title or Position: DIRECTOR OF STUDENT AFFAIRS
Credential:
Phone: 212-256-0846