# STATEN ISLAND DEVELOPMENTAL DISABILITIES SERVICES OFFICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144423062
- **Authorized official:** DR. DAVID E BOOTH PH.D (DIRECTOR)
- **Authorized official phone:** (718) 983-5321

## Contact information

- **Practice address:** 1150 FOREST HILL RD, STATEN ISLAND, NY 10314-6316
- **Practice address phone:** (718) 983-5365
- **Practice address fax:** (718) 983-5462
- **Mailing address:** 1150 FOREST HILL RD, STATEN ISLAND, NY 10314-6316
- **Mailing address phone:** (718) 983-5365
- **Mailing address fax:** (718) 983-5462

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | 006544 | NY | Yes |

## Other

- **Enumeration date:** 06/07/2007
- **Last updated:** 03/07/2023