Basic Information
| Provider Information | |||||||||
| NPI: | 1225287758 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LOS NINOS SERVICES | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 535 8TH AVENUE | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100184304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127879700 | ||||||||
| FaxNumber: | 2127874418 | ||||||||
| Practice Location | |||||||||
| Address1: | 535 8TH AVENUE | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100184304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127879700 | ||||||||
| FaxNumber: | 2127874418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | DIAZ | ||||||||
| AuthorizedOfficialFirstName: | EDITA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2127879700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 251B00000X | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 56900 | 01 | NY | NEW YORK CITY EIP | OTHER |