Healthcare Provider Details

I. General information

NPI: 1205862950
Provider Name (Legal Business Name): SAMUEL FIELD YM&YWHA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59-28 LITTLE NECK PARKWAY
LITTLE NECK NY
11362
US

IV. Provider business mailing address

5820 LITTLE NECK PKWY
LITTLE NECK NY
11362-2530
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-0566
  • Fax: 718-224-7544
Mailing address:
  • Phone: 718-225-6750
  • Fax: 718-224-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number8600150A
License Number StateNY

VIII. Authorized Official

Name: MRS. DANIELLE ELLMAN
Title or Position: EXECUTIVE VICE PRESIDENT & CEO
Credential:
Phone: 718-225-0566