NPIMap

Organization Active NPI

Icl-East New York Prevention-Based Satellite

  • Community/Behavioral Health Agency
  • New York, NY
National Provider Identifier
1902054943
Registry record updated Sep 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
7720101B Issued in NY
Legal business name
ICL-EAST NEW YORK PREVENTION-BASED SATELLITE
Practice address
40 Rector St FL 11
New York, NY 10006-1705
Phone
(212) 385-3030
NPI assigned
Sep 3, 2008
Organization subpart
Yes
Parent organization
INSTITUTE FOR COMMUNITY LIVING, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2008

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

Authorized official

Name
Mr. Dewey Howard
Title
C F O
Phone
(212) 385-3030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 7720101B NY Primary

Addresses

Primary practice location

40 Rector St FL 11
New York, NY 10006-1705

Mailing address

350 Linwood St
Brooklyn, NY 11208-2116

Other identifiers 1

IdentifierTypeStateIssuer
7720101BMedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Icl Individual Support Services35 organizations share this tax ID, including this one
Part of
Icl Individual Support Services

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

Locations

40 Rector St
Fl 11
New York, NY 10006
Phone (718) 855-7485

NPI Registry JSON

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220400000000",
    "number": "1902054943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 LINWOOD ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112082116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 RECTOR ST FL 11",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100061705",
            "telephone_number": "212-385-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICL-EAST NEW YORK PREVENTION-BASED SATELLITE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INSTITUTE FOR COMMUNITY LIVING, INC.",
        "enumeration_date": "2008-09-03",
        "last_updated": "2008-09-03",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "DEWEY",
        "authorized_official_title_or_position": "C F O",
        "authorized_official_telephone_number": "212-385-3030",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NY",
            "license": "7720101B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7720101B",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; 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.