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General NPI Number Information
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NPI Number | 1104027952
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Entity Type | Organization
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Legal Business Name | INCARNATION CHILDREN'S CENTER
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 142 AUDUBON AVE
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City | NEW YORK
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State | NY
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Zip | 10032-2102
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Country | US
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Telephone | 212-928-2590
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Fax | 212-928-1500
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Provider Business Mailing Address
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Address Line | 142 AUDUBON AVE
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City | NEW YORK
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State | NY
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Zip | 10032-2102
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Country | US
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Telephone | 212-928-2590
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Fax | 212-928-1500
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Authorized Official
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Title or Position | VICE PRESIDENT OF FINANCE
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Name | BRUCE ADLER
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Credential |
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Telephone | 646-633-4710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 7002357N
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License Number State | NY
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