Healthcare Provider Details

I. General information

NPI: 1730207119
Provider Name (Legal Business Name): GREENWICH HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 WEST 27TH STREET 6TH FLOOR
NEW YORK NY
10001
US

IV. Provider business mailing address

27 BARROW STREET
NEW YORK NY
10014-3823
US

V. Phone/Fax

Practice location:
  • Phone: 212-691-2900
  • Fax: 212-675-2985
Mailing address:
  • Phone: 212-991-0003
  • Fax: 212-366-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number136328
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number211187
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number210573
License Number StateNY

VIII. Authorized Official

Name: MR. ROY LEAVITT
Title or Position: EXECUTIVE DIRECTOR/CEO
Credential:
Phone: 212-991-0003