Basic Information
| Provider Information | |||||||||
| NPI: | 1548449184 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FEDERATION EMPLOYMENT AND GUIDANCE SERVICE, INC | ||||||||
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| OtherOrganizationName: | FEGS HEALTH AND HUMAN SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 HUDSON ST | ||||||||
| Address2: | NEW YORK | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100131009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123668035 | ||||||||
| FaxNumber: | 2123668069 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 EAST GUN HILL ROAD | ||||||||
| Address2: | EVANDER CHILDS CAMPUS | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473268488 | ||||||||
| FaxNumber: | 3472028487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2007 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | WOODLOCK | ||||||||
| AuthorizedOfficialFirstName: | KRISTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 2123668402 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | 6287112C | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 00257805 | 05 | NY | MEDICAID |