1467529115 NPI number — COMMUNITY HEALTHCARE NETWORK INC

Table of content: (NPI 1467529115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467529115 NPI number — COMMUNITY HEALTHCARE NETWORK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTHCARE NETWORK INC
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:
COMMUNITY LEAGUE HEALTH CENTER
Provider Other Organization Name Type Code:
3
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:
1467529115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 MADISON AVE
Provider Second Line Business Mailing Address:
FLOOR 5
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10010-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-545-2439
Provider Business Mailing Address Fax Number:
646-312-0481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 WEST 157TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10032-5058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-781-7979
Provider Business Practice Location Address Fax Number:
212-781-7963
Provider Enumeration Date:
11/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WENGROFSKY
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
212-545-2481

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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: 00695941 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".