1972964575 NPI number — NEW YORK STATE OFFICE OF MENTAL HEALTH

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 1972964575 NPI number — NEW YORK STATE OFFICE OF MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK STATE OFFICE OF MENTAL HEALTH
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:
1972964575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 SEAVIEW AVE.
Provider Second Line Business Mailing Address:
SBPC;HEALTH HOME PROGRAM
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-668-8061
Provider Business Mailing Address Fax Number:
718-668-8070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 SEAVIEW AVE
Provider Second Line Business Practice Location Address:
SBPC;HEALTH HOME PROGRAM
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10305-3409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-668-8061
Provider Business Practice Location Address Fax Number:
718-668-8070
Provider Enumeration Date:
03/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM COORDINATOR
Authorized Official Telephone Number:
718-668-8061

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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