Basic Information
| Provider Information | |||||||||
| NPI: | 1215185269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGH SCHOOL FOR TELECOMMUNICATION ART & TECHNOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 67TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112205301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123853030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 67TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112205301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123853030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 09/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | DEWEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | C F O | ||||||||
| AuthorizedOfficialTelephone: | 2123853030 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INSTITUTE FOR COMMUNITY LIVING, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 6965100D | NY | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 00245065 | 05 | NY | MEDICAID |