Healthcare Provider Details

I. General information

NPI: 1164453312
Provider Name (Legal Business Name): SLR PSYCHIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 AMSTERDAM AVE SUITE 16C
NEW YORK NY
10025-1737
US

IV. Provider business mailing address

1090 AMSTERDAM AVE SUITE 16C
NEW YORK NY
10025-1737
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-2965
  • Fax: 212-636-1303
Mailing address:
  • Phone: 212-523-2965
  • Fax: 212-636-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: DIANE M HACK
Title or Position: BILLING MANAGER
Credential:
Phone: 212-523-2965