Healthcare Provider Details

I. General information

NPI: 1114369642
Provider Name (Legal Business Name): NEIGHBORHOOD CHANGE YOUTH ORGANIZATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 SENECA ST
STATEN ISLAND NY
10310-2334
US

IV. Provider business mailing address

88 SENECA ST
STATEN ISLAND NY
10310-2334
US

V. Phone/Fax

Practice location:
  • Phone: 718-981-0445
  • Fax:
Mailing address:
  • Phone: 718-981-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number609775
License Number StateNY

VIII. Authorized Official

Name: MS. TAKISHA L COLLINS
Title or Position: EXECUTIVE DIRECTOR
Credential: EDUCATOR
Phone: 718-981-0445