MEDICARE: FEDERATION OF ORGANIZATIONS FOR THE NY STATE MENTALLY DISABLED 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
1	261QM0850X	Adult Mental Health Clinic/Center	02644553	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316006042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEDERATION OF ORGANIZATIONS FOR THE NY STATE MENTALLY DISABLED INC

Provider Business Mailing Address
First Line	:	1 FARMINGDALE ROAD
Second Line	:	ROUTE 109
City	:	WEST BABYLON
State	:	NY
Zip	:	11704
Country	:	US
Telephone Number	:	631-669-5355
Fax Number	:	631-669-1114

Provider Business Practice Location Address
First Line	:	2830 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-3220
Country	:	US
Telephone Number	:	718-235-8690
Fax Number	:	718-235-8871

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. STEPHEN MCCARTHY
Credential	:
Telephone Number	:	631-669-5355

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	05/14/2015

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