Healthcare Provider Details

I. General information

NPI: 1740211143
Provider Name (Legal Business Name): SERVICE PROGRAM FOR OLDER PEOPLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W 91ST ST
NEW YORK NY
10024-1011
US

IV. Provider business mailing address

302 W 91ST ST 2ND FLR
NEW YORK NY
10024-1011
US

V. Phone/Fax

Practice location:
  • Phone: 212-787-7120
  • Fax:
Mailing address:
  • Phone: 212-787-7120
  • Fax: 212-580-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCY HARVEY
Title or Position: EXEC DIRECTOR
Credential: LMSW
Phone: 212-787-7120