1396071825 NPI number — NY CENTER FOR BEHAVIORAL HEALTH, 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 1396071825 NPI number — NY CENTER FOR BEHAVIORAL HEALTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NY CENTER FOR BEHAVIORAL HEALTH, 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:
1396071825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2018
NPI Reactivation Date:
03/27/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
287 NORTHERN BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GREAT NECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11021-4717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-487-4202
Provider Business Mailing Address Fax Number:
201-692-0234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
287 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GREAT NECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11021-4717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-487-4202
Provider Business Practice Location Address Fax Number:
201-692-0234
Provider Enumeration Date:
10/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KLUGER
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
516-487-4202

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  10139 , 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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