Healthcare Provider Details

I. General information

NPI: 1295808020
Provider Name (Legal Business Name): ICD INTERNATIONAL CENTER FOR THE DISABLED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E 24TH ST
NEW YORK NY
10010-4019
US

IV. Provider business mailing address

340 E 24TH ST
NEW YORK NY
10010-4019
US

V. Phone/Fax

Practice location:
  • Phone: 212-585-6000
  • Fax: 212-585-6262
Mailing address:
  • Phone: 212-585-6000
  • Fax: 212-585-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number70022112R
License Number StateNY

VIII. Authorized Official

Name: DR. LES HALPERT
Title or Position: CEO AND PRESIDENT
Credential: PH.D
Phone: 212-585-6009