1104035484 NPI number — ADDICTION RESEACH TREATMENT CORP.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104035484 NPI number — ADDICTION RESEACH TREATMENT CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADDICTION RESEACH TREATMENT CORP.
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:
6
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:
1104035484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 NORMAN AVE.
Provider Second Line Business Mailing Address:
APT 2L
Provider Business Mailing Address City Name:
NYC
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
11222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
937 FULTON ST.
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
NYC
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
171-863-6001
Provider Business Practice Location Address Fax Number:
718-638-5167
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PITTAS
Authorized Official First Name:
DEMO
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
17186360015

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , 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)





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