=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023287547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUNG ADULT INSTITUTE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2008
-----------------------------------------------------
Last Update Date | 09/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 314 E 35TH ST STE 3
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-3760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-779-7983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 460 W 34TH ST FL 11
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-2382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-273-6100
-----------------------------------------------------
Fax | 212-273-6406
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR ACCTS RECEIVABLE
-----------------------------------------------------
Name | MR. ROBERT PITTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 212-273-6625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number | 7329457
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------