1669548046 NPI number — BROOKLYN BUREAU OF COMMUNITY SERVICE

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 1669548046 NPI number — BROOKLYN BUREAU OF COMMUNITY SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKLYN BUREAU OF COMMUNITY SERVICE
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:
1669548046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 ATLANTIC AVENUE 2ND FLOOR
Provider Second Line Business Mailing Address:
DAY HABILITATION SERVICES BROOKLYN BUREAU OF COMMUNITY
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11217-1024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-943-4247
Provider Business Mailing Address Fax Number:
718-596-4589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 ATLANTIC AVENUE 2ND FLOOR
Provider Second Line Business Practice Location Address:
DAY HABILITATION SERVICES
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11217-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-943-4247
Provider Business Practice Location Address Fax Number:
718-596-4589
Provider Enumeration Date:
11/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
DIRECTOR ADULT REHABILITATION SERVI
Authorized Official Telephone Number:
718-310-5630

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02703991 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".