Provider Demographics
NPI:1750441945
Name:THE CENTER FOR DEVELOPMENTAL DISABILITIES
Entity type:Organization
Organization Name:THE CENTER FOR DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-921-7650
Mailing Address - Street 1:72 S WOODS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1024
Mailing Address - Country:US
Mailing Address - Phone:516-921-7650
Mailing Address - Fax:
Practice Address - Street 1:72 S WOODS RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1024
Practice Address - Country:US
Practice Address - Phone:516-921-7650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21680251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00942392Medicaid
NY01008828Medicaid
NY00244940Medicaid
NY01153328Medicaid
NY00577766Medicaid
NY01224455Medicaid
NY00879598Medicaid
NY00994909Medicaid