Provider Demographics
NPI:1992981625
Name:ANDERSON FOUNDATION FOR AUTISM
Entity type:Organization
Organization Name:ANDERSON FOUNDATION FOR AUTISM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-889-4034
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:STAATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12580-0367
Mailing Address - Country:US
Mailing Address - Phone:845-889-4034
Mailing Address - Fax:845-889-4623
Practice Address - Street 1:4885 ROUTE 9
Practice Address - Street 2:
Practice Address - City:STAATSBURG
Practice Address - State:NY
Practice Address - Zip Code:12580
Practice Address - Country:US
Practice Address - Phone:845-889-4034
Practice Address - Fax:845-889-4623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01995880Medicaid