ICD INTERNATIONAL CENTER FOR THE DISABLED (NPI# 1912100454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912100454 |
| Entity Type | Organization |
| Organization Name | ICD INTERNATIONAL CENTER FOR THE DISABLED |
| Practice Address |
340 E 24th St New York NY 10010-4019 |
| Practice Telephone | 2125856000 |
| Practice Fax Number | 2125856262 |
| Mailing Telephone | 2125856000 |
| Mailing Fax Number | 2125856262 |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2013-01-04 |
| Authorized Official Name | LES HALPERT (PRESIDENT AND CEO) |
| Authorized Official Telephone | 2125856009 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
090110619 | NY | Ambulatory Health Care Facilities |
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
6704100A | NY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00244413 | 05 | |
| NY | NYPRESBY HEALTH PLAN | 58P0081 | 01 |
| NY | FIDELIS CARE NEW YORK | 040816000080 | 01 |
| NY | GHI-BMP | 3186529 | 01 |
| NY | BEACON HEALTH STRATEGIES | 1054350 | 01 |
| NY | PERFORMAX-MULTIPLAN | A31902 | 01 |
| NY | RAILROAD RETIREMENT BOARD | DB5292 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013112358 | Icd International Center for The Disabled | Clinic/Center | 421 E 106th St, New York, NY 10029-4846 | 2007-06-18 |
| 1174726616 | Icd International Center for The Disabled | Clinic/Center | 340 E 24th St, New York, NY 10010-4019 | 2007-06-11 |
| 1295808020 | Icd International Center for The Disabled | Clinic/Center | 340 E 24th St, New York, NY 10010-4019 | 2006-11-17 |
| Street Address |
340 E 24TH ST |
| City | NEW YORK |
| State | NY |
| Zip Code | 10010-4019 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912984147 | Andrew Michael Petronio | Social Worker | 340 E 24th St, Office 528, New York, NY 10010-4019 | 2005-12-29 |
| 1700137387 | Michelle Palmer Boonswang | Student in an Organized Health Care Education/Training Program | 340 E 24th St, New York, NY 10010-4019 | 2012-09-24 |
| 1689954646 | Sandra Anne Kupprat | Student in an Organized Health Care Education/Training Program | 340 E 24th St, New York, NY 10010-4019 | 2011-08-23 |
| 1225320724 | Lisa Corinne Kearny | Occupational Therapist | 340 E 24th St, New York, NY 10010-4019 | 2011-05-03 |
| 1831495001 | Catherine O'neill | Registered Nurse | 340 E 24th St, New York, NY 10010-4019 | 2011-02-04 |
| 1235434333 | Xiomara Amanda Migliorino | Counselor | 340 E 24th St, Suite 311, New York, NY 10010-4019 | 2011-01-20 |
| 1346540838 | Amy Dimun | Counselor | 340 E 24th St, New York, NY 10010-4019 | 2010-10-30 |
| 1336449222 | International Center for The Disabled | Clinic/Center | 340 E 24th St, Suite 311, New York, NY 10010-4019 | 2010-10-26 |
| 1407163033 | Victoria Olivotti | Speech-Language Pathologist | 340 E 24th St, New York, NY 10010-4019 | 2010-09-02 |
| 1710299011 | Sacha Khaloyan | Occupational Therapist | 340 E 24th St, New York, NY 10010-4019 | 2010-07-02 |
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| 1437779766 | Sunny Makhijani | Student in an Organized Health Care Education/Training Program | 423 E 23rd St, New York, Ny 10010, New York, NY 10010 | 2020-04-16 |
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| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.