Organization
THE CHILD CENTER OF NY
Active
Other names
IS 59
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEAN M COPPOLA (BILLING MANAGER)
(718) 651-7770
Entity
Organization
Contact information
Practice address
18998 RIDGEDALE ST, ROOM 116C, SPRINGFIELD GARDENS, NY 11413
(718) 659-4000
Mailing address
6002 QUEENS BLVD, LOWER LEVEL, WOODSIDE, NY 11377-4973
(718) 651-7770
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
6734122F
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00244371
—
NY
01
—
7403085
GHI
NY
01
—
WV0071
BLUE CROSS/BLUE SHIELD
NY
Enumeration date
08/29/2008
Last updated
08/29/2008
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