Healthcare Provider Details

I. General information

NPI: 1124166145
Provider Name (Legal Business Name): LINCOLN MEDICAL & MENTAL HEATH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451-5504
US

IV. Provider business mailing address

25 NEPTUNE BLVD APT 8R
LONG BEACH NY
11561-4654
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5156
  • Fax:
Mailing address:
  • Phone: 516-431-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number000334
License Number StateNY

VIII. Authorized Official

Name: MR. DAVID W. GOLDBERG
Title or Position: LICENSED MENTAL HEATH COUNSELOR
Credential: MS. ED
Phone: 718-579-5156