Healthcare Provider Details

I. General information

NPI: 1275420689
Provider Name (Legal Business Name): NEW START FOR BRIGHT MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 E 169TH ST # 1314
BRONX NY
10456-2623
US

IV. Provider business mailing address

638 E 169TH ST # 1314
BRONX NY
10456-2623
US

V. Phone/Fax

Practice location:
  • Phone: 929-256-5005
  • Fax: 929-256-5006
Mailing address:
  • Phone: 929-256-5005
  • Fax: 929-256-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: HECTOR DARIO REYES
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 917-771-9827