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General NPI Number Information
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NPI Number | 1568559581
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Entity Type | Organization
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Legal Business Name | LIFELINE CENTER FOR CHILD DEVELOPMENT
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8009 WINCHESTER BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427
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Country | US
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Telephone | 718-740-4300
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Fax | 718-217-9566
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Provider Business Mailing Address
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Address Line | 8009 WINCHESTER BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427
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Country | US
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Telephone | 718-740-4300
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Fax | 718-217-9566
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JOSEPH ZACHERMAN
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Credential | PHD
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Telephone | 718-740-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 06000113345
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License Number State | NY
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