Healthcare Provider Details

I. General information

NPI: 1952676561
Provider Name (Legal Business Name): IMOLLOY COLLEGE REBECCA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEMPSTEAD AVE
ROCKVILLE CENTRE NY
11571-5002
US

IV. Provider business mailing address

1000 HEMPSTEAD AVE
ROCKVILLE CENTRE NY
11571-5002
US

V. Phone/Fax

Practice location:
  • Phone: 516-678-5000
  • Fax: 516-255-4823
Mailing address:
  • Phone: 516-678-5000
  • Fax: 516-255-4823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number015451
License Number StateNY

VIII. Authorized Official

Name: DR. JOHN A. CARPENTE
Title or Position: CLINICAL DIRECTOR
Credential: PH.D.
Phone: 516-678-5000