Healthcare Provider Details

I. General information

NPI: 1063950418
Provider Name (Legal Business Name): THE NEW YORK MILK BANK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 OLD BROADWAY
HASTINGS ON HUDSON NY
10706-3801
US

IV. Provider business mailing address

185 OLD BROADWAY
HASTINGS ON HUDSON NY
10706-3801
US

V. Phone/Fax

Practice location:
  • Phone: 212-956-6455
  • Fax: 914-471-9703
Mailing address:
  • Phone: 212-956-6455
  • Fax: 914-471-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberHM019
License Number StateNY

VIII. Authorized Official

Name: MRS. JULIE BOUCHET-HORWITZ
Title or Position: EXECUTIVE DIRECTOR
Credential: FNP-BC
Phone: 212-956-5455