1053408211 NPI number — CENTER FOR URBAN COMMUNITY SERVICES

Table of content: (NPI 1053408211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053408211 NPI number — CENTER FOR URBAN COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR URBAN COMMUNITY SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053408211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
198 EAST 121ST STREET
Provider Second Line Business Mailing Address:
6TH FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-801-3300
Provider Business Mailing Address Fax Number:
212-635-2191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1307 SOUTHERN BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-519-8326
Provider Business Practice Location Address Fax Number:
718-881-8714
Provider Enumeration Date:
10/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
DOUG
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
646-755-6448

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  7964475A , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02419950 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02713064 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".