Basic Information
| Provider Information | |||||||||
| NPI: | 1336449222 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNATIONAL CENTER FOR THE DISABLED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 W 115TH ST | ||||||||
| Address2: | APT 6A | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100262900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3475000017 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 E 24TH ST | ||||||||
| Address2: | SUITE 311 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100104019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125856221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2010 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | MIGLIORINO | ||||||||
| AuthorizedOfficialFirstName: | XIOMARA | ||||||||
| AuthorizedOfficialMiddleName: | AMANDA | ||||||||
| AuthorizedOfficialTitleorPosition: | SUBSTANCE ABUSE COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 2125856221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | CASAC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 110110619 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.