National Provider Identifier Database

MENORAH PARK GROUP RESIDENTS
Developmental Disabilities

An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).


Contact Information

MENORAH PARK GROUP RESIDENTS
12 JAMAR DRIVE
DEWITT, NY13066
Phone: 315-446-9111
Fax:
Website:
Specialty Taxonomy Code
* Developmental Disabilities 261QD1600X

* Indicates primary specialty

NPI Profile & details for MENORAH PARK GROUP RESIDENTS

NPI Number 1689815805
Legal business name
LBN
MENORAH PARK GROUP RESIDENTS
Authorized official TONI COLE - (OFFICE)
Entity Organization
Organization subpart No
Enumeration date 03/18/2009
Last updated 03/18/2009 - About 17 years ago
Sole proprietor1 Not specified
Identifiers
  • NY License #: SPV46480
  • NY Medicaid: 03035921

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for MENORAH PARK GROUP RESIDENTS

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