Healthcare Provider Details

I. General information

NPI: 1083921837
Provider Name (Legal Business Name): SAFE SPACE NYC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 LAFAYETTE ST
NEW YORK NY
10012-2793
US

IV. Provider business mailing address

295 LAFAYETTE ST
NEW YORK NY
10012-2793
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-2400
  • Fax:
Mailing address:
  • Phone: 718-526-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number72081755
License Number StateNY

VIII. Authorized Official

Name: MS. CHRISTINE MOLNAR
Title or Position: CEO
Credential:
Phone: 718-526-2400