Healthcare Provider Details

I. General information

NPI: 1184957409
Provider Name (Legal Business Name): COMUNILIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W 29TH ST
NEW YORK NY
10001-5203
US

IV. Provider business mailing address

214 W 29TH ST
NEW YORK NY
10001-5203
US

V. Phone/Fax

Practice location:
  • Phone: 212-219-1618
  • Fax:
Mailing address:
  • Phone: 212-219-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number61526329
License Number StateNY

VIII. Authorized Official

Name: MR. FRANK BADILLO
Title or Position: CLINIC DIRECTOR
Credential: MSW
Phone: 718-364-7700