1619354552 NPI number — SERVICES FOR THE UNDERSERVED, INC.

Table of content: (NPI 1619354552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619354552 NPI number — SERVICES FOR THE UNDERSERVED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVICES FOR THE UNDERSERVED, 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:
1619354552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 7TH AVE
Provider Second Line Business Mailing Address:
10TH FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001-6008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-408-1642
Provider Business Mailing Address Fax Number:
855-370-9384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101-38 92ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OZONE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11416-2205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-408-1642
Provider Business Practice Location Address Fax Number:
855-370-9384
Provider Enumeration Date:
04/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
YANG
Authorized Official First Name:
LIN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR - MEDICAID BILLING
Authorized Official Telephone Number:
917-408-1642

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  7559303 , 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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