1225287402 NPI number — MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, INC.

Table of content: (NPI 1225287402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225287402 NPI number — MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, 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:
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:
1225287402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 W 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10550-4002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-699-7200
Provider Business Mailing Address Fax Number:
914-699-0837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 KNOLLWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE PLAINS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-699-7200
Provider Business Practice Location Address Fax Number:
914-699-0837
Provider Enumeration Date:
09/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
MAXINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR PATIENT FINANCIAL SERVICES
Authorized Official Telephone Number:
914-989-7600

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  5903200R , 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: 00926581 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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