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General NPI Number Information
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NPI Number | 1609731082
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND CENTER FOR INDEPENDENT LIVING INC.
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Dates
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Enumeration Date | 12/18/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 470 CASTLETON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2118
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Country | US
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Telephone | 718-720-9016
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Fax |
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Provider Business Mailing Address
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Address Line | 470 CASTLETON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2118
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JERRY ALLEN CARNEGIE
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Credential |
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Telephone | 213-952-9523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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