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NPI Code Detail

MEDICARE: THE CHILD CENTER OF NY, INC.

MEDICARE: THE CHILD CENTER OF NY, 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
1261QM0855XAdolescent and Children Mental Health Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27403085OTHERNYGHI
3WV0071OTHERNYBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1649329806
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE CHILD CENTER OF NY, INC.
Provider Business Mailing Address
First Line : 11835 QUEENS BLVD
Second Line : 6TH FLOOR
City : FOREST HILLS
State : NY
Zip : 11375-7211
Country : US
Telephone Number : 718-651-7770
Fax Number : 718-396-8349
Provider Business Practice Location Address
First Line : 11835 QUEENS BLVD
Second Line : 6TH FLOOR
City : FOREST HILLS
State : NY
Zip : 11375-7211
Country : US
Telephone Number : 718-651-7770
Fax Number : 718-396-8349
Authorized Official
Title or Position : BILLING SYSTEM ADMINISTRATOR
Name : MS. JEAN M COPPOLA
Credential :
Telephone Number : 718-651-7770
Provider Enumeration Date : 01/09/2007
Last Update Date : 01/18/2017

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