MEDICARE: YOUNG ADULT INSTITUTE, 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	6113310	NY

General Provider Information

NPI Number	:	1710136890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG ADULT INSTITUTE, INC.

Provider Business Mailing Address
First Line	:	460 W 34TH ST
Second Line	:	FL 11
City	:	NEW YORK
State	:	NY
Zip	:	10001-2382
Country	:	US
Telephone Number	:	212-273-6100
Fax Number	:	212-273-6406

Provider Business Practice Location Address
First Line	:	460 W 34TH ST
Second Line	:	FL 11
City	:	NEW YORK
State	:	NY
Zip	:	10001-2382
Country	:	US
Telephone Number	:	212-273-6100
Fax Number	:	212-273-6406

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MS. LAURA LYSTON
Credential	:
Telephone Number	:	212-273-6233

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	08/18/2009

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