Healthcare Provider Details

I. General information

NPI: 1679620090
Provider Name (Legal Business Name): THE DOOR - A CENTER OF ALTERNATIVES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 AVENUE OF THE AMERICAS
NEW YORK NY
10013-1510
US

IV. Provider business mailing address

121 AVENUE OF THE AMERICAS
NEW YORK NY
10013-1510
US

V. Phone/Fax

Practice location:
  • Phone: 212-941-9090
  • Fax: 212-941-9614
Mailing address:
  • Phone: 212-941-9090
  • Fax: 212-941-9614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number118888-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: MS. RENEE M MCCONEY
Title or Position: DIRECTOR OF ADOLESCENT HEALTH SERVI
Credential: MS
Phone: 212-453-0209