Basic Information
| Provider Information | |||||||||
| NPI: | 1629443437 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE HANDICAPPED CHILDREN'S ASSOCIATION OF SOUTHERN NEW YORK, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HCA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 GRAND AVE. | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137902198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072170066 | ||||||||
| FaxNumber: | 6072170069 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 BROAD ST. | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137902198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077987117 | ||||||||
| FaxNumber: | 6077980074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2015 | ||||||||
| LastUpdateDate: | 02/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | SANO | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXEC. DIR. | ||||||||
| AuthorizedOfficialTelephone: | 6077987117 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE HANDICAPPED CHILDREN'S ASSOCIATION OF SOUTHERN NEW YORK, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD1600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No ID Information.