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General NPI Number Information
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NPI Number | 1295808020
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Entity Type | Organization
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Legal Business Name | ICD INTERNATIONAL CENTER FOR THE DISABLED
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 340 E 24TH ST
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City | NEW YORK
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State | NY
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Zip | 10010-4019
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Country | US
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Telephone | 212-585-6000
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Fax | 212-585-6262
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Provider Business Mailing Address
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Address Line | 340 E 24TH ST
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City | NEW YORK
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State | NY
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Zip | 10010-4019
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Country | US
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Telephone | 212-585-6000
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Fax | 212-585-6262
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Authorized Official
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Title or Position | CEO AND PRESIDENT
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Name | DR. LES HALPERT
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Credential | PH.D
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Telephone | 212-585-6009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 70022112R
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License Number State | NY
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