Provider Demographics
NPI:1487721726
Name:KENNEDY CHILDREN'S CENTER
Entity type:Organization
Organization Name:KENNEDY CHILDREN'S CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-988-9500
Mailing Address - Street 1:2212 3RD AVE.
Mailing Address - Street 2:2ND FLR.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-5998
Mailing Address - Country:US
Mailing Address - Phone:212-988-9500
Mailing Address - Fax:212-831-3905
Practice Address - Street 1:2212 3RD AVE.
Practice Address - Street 2:2ND FLR.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-5998
Practice Address - Country:US
Practice Address - Phone:212-988-9500
Practice Address - Fax:212-831-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244844Medicaid