1356468540 NPI number — PROJECT HOSPITALITY INC.

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 1356468540 NPI number — PROJECT HOSPITALITY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROJECT HOSPITALITY 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:
PROJECT HOSPITALITY RECOVERY PROGRAM
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:
1356468540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10302-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-448-1544
Provider Business Mailing Address Fax Number:
718-720-5476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 SLOSSON TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10301-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-273-8409
Provider Business Practice Location Address Fax Number:
718-273-5265
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TROIA
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
718-448-1544

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  151110948 , 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: 01292593 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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