1871977009 NPI number — PSC COMMUNITY SUPPORT SERVICES, INC.

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 1871977009 NPI number — PSC COMMUNITY SUPPORT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSC COMMUNITY SUPPORT SERVICES, 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:
1871977009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5102 21ST ST
Provider Second Line Business Mailing Address:
FOURTH FLOOR - 4-A
Provider Business Mailing Address City Name:
LONG ISLAND CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11101-5357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-349-1905
Provider Business Mailing Address Fax Number:
718-349-0908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5102 21ST ST
Provider Second Line Business Practice Location Address:
FOURTH FLOOR - 4-A
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11101-5357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-349-1905
Provider Business Practice Location Address Fax Number:
718-349-0908
Provider Enumeration Date:
07/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
OLECHOWSKI
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
718-349-1905

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  1997L001 , 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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