MEDICARE: NEW YORK CENTER FOR CHILD DEVELOPMENT

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
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1306174123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK CENTER FOR CHILD DEVELOPMENT

Provider Business Mailing Address
First Line	:	159 WEST 127TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027
Country	:	US
Telephone Number	:	212-752-7575
Fax Number	:	212-752-7564

Provider Business Practice Location Address
First Line	:	159 W 127TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-3723
Country	:	US
Telephone Number	:	212-752-7575
Fax Number	:	212-752-7564

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MICHAEL GORDON
Credential	:
Telephone Number	:	212-752-7575

Provider Enumeration Date	:	12/07/2009
Last Update Date	:	07/21/2022

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