1629240338 NPI number — HEARTSHARE HUMAN SERVICES OF NEW YORK

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 1629240338 NPI number — HEARTSHARE HUMAN SERVICES OF NEW YORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTSHARE HUMAN SERVICES OF NEW YORK
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:
1629240338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 METROTECH CTR
Provider Second Line Business Mailing Address:
29TH FLOOR
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-422-3229
Provider Business Mailing Address Fax Number:
718-852-6339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 METROTECH CTR
Provider Second Line Business Practice Location Address:
29TH FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-422-3229
Provider Business Practice Location Address Fax Number:
718-852-6339
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PITRE
Authorized Official First Name:
CARMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SUPERVISOR
Authorized Official Telephone Number:
718-422-3229

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01384798 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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