MEDICARE: THE INSTITUTES OF APPLIED HUMAN DYNAMICS

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1770702458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE INSTITUTES OF APPLIED HUMAN DYNAMICS

Provider Business Mailing Address
First Line	:	3625 BAINBRIDGE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-1168
Country	:	US
Telephone Number	:	718-920-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 CROTON LAKE RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-6216
Country	:	US
Telephone Number	:	718-920-0806
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF THE BILLING DEPARTMENT
Name	:	MARY K ST. MARK
Credential	:
Telephone Number	:	718-920-0806

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	05/07/2008

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