Organization
ICL INDIVIDUAL SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEWEY HOWARD (CFO)
(212) 385-3030
Entity
Organization
Contact information
Practice address
40 RECTOR ST FL 11, NEW YORK, NY 10006-1705
(212) 385-3030
Mailing address
40 RECTOR ST FL 11, NEW YORK, NY 10006-1705
(212) 385-3030
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0141009
—
NY
Enumeration date
12/29/2009
Last updated
12/29/2009
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