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NPI Code Detail

MEDICARE: SAMARITAN DAYTOP VILLAGE, INC.

MEDICARE: SAMARITAN DAYTOP VILLAGE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility16890NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
103A0973OTHERNYNYDS-DOH LICENSE #
216890OTHERNYNYS-OASAS PROVIDER #
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4PRU-393OTHERNYNYS-OASAS PROG.REPORT#
5080510352OTHERNYNYS-OASAS CD OPR.CERT.

General Provider Information

NPI Number : 1396822839
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAMARITAN DAYTOP VILLAGE, INC.
Provider Business Mailing Address
First Line : 13802 QUEENS BLVD
Second Line :
City : BRIARWOOD
State : NY
Zip : 11435-2642
Country : US
Telephone Number : 718-206-2000
Fax Number : 718-206-4055
Provider Business Practice Location Address
First Line : 13020 89TH RD
Second Line :
City : RICHMOND HILL
State : NY
Zip : 11418-3301
Country : US
Telephone Number : 718-441-8913
Fax Number : 718-805-6041
Authorized Official
Title or Position : VICE PRESIDENT OF HEALTH & COMM
Name : MR. CHARLES MADRAY
Credential :
Telephone Number : 718-764-4249
Provider Enumeration Date : 11/01/2006
Last Update Date : 03/07/2023

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