Healthcare Provider Details

I. General information

NPI: 1194030320
Provider Name (Legal Business Name): CIS COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 JOHN ST FL 27
NEW YORK NY
10038-3414
US

IV. Provider business mailing address

116 JOHN ST FL 27
NEW YORK NY
10038-3414
US

V. Phone/Fax

Practice location:
  • Phone: 212-385-0086
  • Fax: 212-732-0757
Mailing address:
  • Phone: 212-385-0086
  • Fax: 212-732-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1548324652
License Number StateNY

VIII. Authorized Official

Name: MR. JACK SCHNITT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 212-385-0086