Healthcare Provider Details

I. General information

NPI: 1376598466
Provider Name (Legal Business Name): PESACH TIKVAH HOPE DEVELOPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MIDDLETON ST
BROOKLYN NY
11206-5415
US

IV. Provider business mailing address

18 MIDDLETON ST
BROOKLYN NY
11206-5415
US

V. Phone/Fax

Practice location:
  • Phone: 718-875-6900
  • Fax: 718-875-3282
Mailing address:
  • Phone: 718-875-6900
  • Fax: 718-875-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7679100A
License Number StateNY

VIII. Authorized Official

Name: MRS. BAS SHEVY MILLER
Title or Position: COMPTROLLER
Credential: CPA
Phone: 718-875-6900