Organization
ICL EAST 225TH STREET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LYNETTE BACCHUS (ASSIST CONTROLLER)
(212) 385-3030
Entity
Organization
Contact information
Practice address
857 E 225TH ST, BRONX, NY 10466-4405
(718) 231-0576
Mailing address
857 E 225TH ST, BRONX, NY 10466-4405
(718) 231-0576
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
03/04/2019
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