1902298359 NPI number — ABBOTT HOUSE

Table of content: (NPI 1902298359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902298359 NPI number — ABBOTT HOUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABBOTT HOUSE
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:
ABBOTT HOUSE CLINICAL AND COUNSELING SERVICES
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:
1902298359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINGTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10533-1254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-591-7300
Provider Business Mailing Address Fax Number:
914-591-3236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N BROADWAY # 6501242
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10533-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-591-7300
Provider Business Practice Location Address Fax Number:
914-650-1242
Provider Enumeration Date:
02/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FINN
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
914-591-7300

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  8532430 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02704061 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01994458 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01358772 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02633374 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01364465 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02923559 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01353891 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04173759 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00333808 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01994476 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02257812 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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