Healthcare Provider Details

I. General information

NPI: 1750441945
Provider Name (Legal Business Name): THE CENTER FOR DEVELOPMENTAL DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 S WOODS RD
WOODBURY NY
11797-1024
US

IV. Provider business mailing address

72 S WOODS RD
WOODBURY NY
11797-1024
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-7650
  • Fax:
Mailing address:
  • Phone: 516-921-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number21680
License Number StateNY

VIII. Authorized Official

Name: CAROLE ANNE BAILO
Title or Position: CONTROLLER
Credential:
Phone: 516-921-7650