Healthcare Provider Details

I. General information

NPI: 1750620290
Provider Name (Legal Business Name): PILGRIM PSYCHIATRIC CENTER NYS CASE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FULTON AVE STE 500
HEMPSTEAD NY
11550-3724
US

IV. Provider business mailing address

175 FULTON AVE, SUITE 500
HEMPSTEAD NY
11550
US

V. Phone/Fax

Practice location:
  • Phone: 516-505-2003
  • Fax: 516-505-2011
Mailing address:
  • Phone: 516-505-2003
  • Fax: 516-505-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: GALAL ALZOKM
Title or Position: COORDINATOR
Credential:
Phone: 631-761-4154