1982623310 NPI number — RIVERDALE MENTAL HEALTH ASSOCIATION INC

Table of content: (NPI 1982623310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982623310 NPI number — RIVERDALE MENTAL HEALTH ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERDALE MENTAL HEALTH ASSOCIATION 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:
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:
1982623310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5676 RIVERDALE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-796-5300
Provider Business Mailing Address Fax Number:
718-548-1161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5676 RIVERDALE AVENUE
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:
10471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-796-5300
Provider Business Practice Location Address Fax Number:
718-548-1161
Provider Enumeration Date:
07/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BREWSTER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
718-796-5300

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 6733300A , 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)