Provider Demographics
NPI:1215756663
Name:WIP NYC, INC
Entity type:Organization
Organization Name:WIP NYC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:LUZENTALES
Authorized Official - Suffix:
Authorized Official - Credentials:MS SPECIAL EDUCATION
Authorized Official - Phone:347-285-5789
Mailing Address - Street 1:6956 CALDWELL AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2636
Mailing Address - Country:US
Mailing Address - Phone:347-285-5789
Mailing Address - Fax:
Practice Address - Street 1:6956 CALDWELL AVE FL 2
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2636
Practice Address - Country:US
Practice Address - Phone:347-285-5789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty