Healthcare Provider Details

I. General information

NPI: 1497894414
Provider Name (Legal Business Name): NYFOUNDLING HOSPITAL AKA ST AGATHAS PELHAM MANOR ICF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHOREVIEW CIRCLE PELHAM MANOR
PELHAM MANOR NY
10803
US

IV. Provider business mailing address

590 AVENUE OF THE AMERICAS
NEW YORK NY
10011
US

V. Phone/Fax

Practice location:
  • Phone: 212-633-9300
  • Fax:
Mailing address:
  • Phone: 212-727-6977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number07107440
License Number StateNY

VIII. Authorized Official

Name: MR. WILLIAM F BACCAGLINI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 212-886-4075