| Is 59 | |
|
18998 Ridgedale St Room 116c Springfield Gardens NY 11413 | |
| (718) 659-4000 | |
| Not Available |
| Full Name | Is 59 |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 18998 Ridgedale St, Springfield Gardens, New York |
| Authorized Official Name and Position | Jean M Coppola (BILLING MANAGER) |
| Authorized Official Contact | 7186517770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Is 59 6002 Queens Blvd Lower Level Woodside NY 11377-4973 Ph: (718) 651-7770 | Is 59 18998 Ridgedale St Room 116c Springfield Gardens NY 11413 Ph: (718) 659-4000 |
| NPI Number | 1730337049 |
|---|---|
| Provider Enumeration Date | 08/29/2008 |
| Last Update Date | 08/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730337049 | NPI | - | NPPES |
| 7403085 | Other | NY | GHI |
| 00244371 | Medicaid | NY | |
| WV0071 | Other | NY | BLUE CROSS/BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 6734122F (New York) | Primary |
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