Basic Information
| Provider Information | |||||||||
| NPI: | 1669411591 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FEDERATION EMPLOYMENT AND GUIDANCE SERVICE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FEGS HEALTH AND HUMAN SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 HUDSON ST | ||||||||
| Address2: | 9TH FL. | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100131009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123668035 | ||||||||
| FaxNumber: | 2123668069 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 CARLETON AVE | ||||||||
| Address2: | |||||||||
| City: | CENTRAL ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117224506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312347807 | ||||||||
| FaxNumber: | 6312348039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 10/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | WOODLOCK | ||||||||
| AuthorizedOfficialFirstName: | KRISTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 2123668402 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 6287103A | NY | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 00257805 | 05 | NY | MEDICAID |