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NPI Code Detail

MEDICARE: INTERDISCIPLINARY CENTER FOR CHILD DEVELOPMENT, INC.

MEDICARE: INTERDISCIPLINARY CENTER FOR CHILD DEVELOPMENT, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD1600XDevelopmental Disabilities Clinic/Center

General Provider Information

NPI Number : 1285910828
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERDISCIPLINARY CENTER FOR CHILD DEVELOPMENT, INC.
Provider Business Mailing Address
First Line : 3555 223RD ST
Second Line :
City : BAYSIDE
State : NY
Zip : 11361-2236
Country : US
Telephone Number : 718-428-5370
Fax Number : 718-428-5462
Provider Business Practice Location Address
First Line : 3555 223RD ST
Second Line :
City : BAYSIDE
State : NY
Zip : 11361-2236
Country : US
Telephone Number : 718-428-5370
Fax Number : 718-428-5462
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. DAVID LOCKER
Credential :
Telephone Number : 718-428-5370
Provider Enumeration Date : 10/27/2011
Last Update Date : 10/27/2011

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