Provider Demographics
NPI:1144555277
Name:CHILD CENTER OF NEW YORK
Entity type:Organization
Organization Name:CHILD CENTER OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ICC
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-651-7770
Mailing Address - Street 1:83-40 AUSTIN STREET #3X
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415
Mailing Address - Country:US
Mailing Address - Phone:718-805-8808
Mailing Address - Fax:
Practice Address - Street 1:8340 AUSTIN ST APT 3X
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1812
Practice Address - Country:US
Practice Address - Phone:718-805-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management