Icl Pacific Street

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

ICL PACIFIC STREET

Practice address

2402A Pacific St
Brooklyn, NY 11233-3430

Phone

(718) 342-9427

NPI assigned

Dec 28, 2009

Last updated

Dec 28, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dewey Howard

Title

Cfo

Phone

(212) 385-3030

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1261958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261958400000",
    "number": "1023348919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402A PACIFIC ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112333430",
            "telephone_number": "718-342-9427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402A PACIFIC ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112333430",
            "telephone_number": "718-342-9427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICL PACIFIC STREET",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-28",
        "last_updated": "2009-12-28",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "DEWEY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "212-385-3030"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01410099",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Developmentally Disabled Services Day Training Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.