Healthcare Provider Details

I. General information

NPI: 1194916858
Provider Name (Legal Business Name): PUBLIC HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 3RD AVE 2ND FLOOR
BRONX NY
10457-4501
US

IV. Provider business mailing address

220 CHURCH ST 5TH FLOOR
NEW YORK NY
10013-2904
US

V. Phone/Fax

Practice location:
  • Phone: 718-294-5891
  • Fax: 718-294-2468
Mailing address:
  • Phone: 646-619-6400
  • Fax: 646-619-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number7002296R
License Number StateNY

VIII. Authorized Official

Name: MS. ELLEN RAUTENBERG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 646-619-6401