Organization
ICL BRONX PARK EAST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEWEY HOWARD (CFO)
(212) 385-3030
Entity
Organization
Contact information
Practice address
3028 BRONX PARK E, BRONX, NY 10467-6704
(718) 994-5938
Mailing address
3028 BRONX PARK E, BRONX, NY 10467-6704
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01410099
—
NY
Enumeration date
12/28/2009
Last updated
12/28/2009
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