MEDICARE: THE HANDICAPPED CHILDREN'S ASSOCIATION OF SOUTHERN NEW YORK, 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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1629443437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE HANDICAPPED CHILDREN'S ASSOCIATION OF SOUTHERN NEW YORK, INC

Provider Business Mailing Address
First Line	:	18 BROAD ST
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790
Country	:	US
Telephone Number	:	607-798-7117
Fax Number	:	607-217-0069

Provider Business Practice Location Address
First Line	:	18 BROAD ST.
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2198
Country	:	US
Telephone Number	:	607-798-7117
Fax Number	:	607-798-0074

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LISA KOST
Credential	:
Telephone Number	:	607-798-7117

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	06/11/2025

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