1629137641 NPI number — BROOKLYN BUREAU OF COMMUNITY SERVICE

Table of content: (NPI 1629137641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629137641 NPI number — BROOKLYN BUREAU OF COMMUNITY SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKLYN BUREAU OF COMMUNITY SERVICE
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:
1629137641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
285 SCHERMERHORN STREET
Provider Second Line Business Mailing Address:
7TH FLOOR
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11217-1024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-310-5633
Provider Business Mailing Address Fax Number:
718-858-2967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 SCHERMERHORN STREET
Provider Second Line Business Practice Location Address:
7TH FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11217-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-310-5633
Provider Business Practice Location Address Fax Number:
718-858-2967
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
DIRECTOR ADULT REHABILITATION SERVI
Authorized Official Telephone Number:
718-310-5630

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  7958001A , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 7958002A , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01525566 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com