Healthcare Provider Details

I. General information

NPI: 1558733584
Provider Name (Legal Business Name): THE BRIDGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 WEST 108TH STREET
NEW YORK NY
10025
US

IV. Provider business mailing address

248 W 108TH ST ROOM 303
NEW YORK NY
10025-2956
US

V. Phone/Fax

Practice location:
  • Phone: 212-663-3000
  • Fax: 212-663-4135
Mailing address:
  • Phone: 212-663-3000
  • Fax: 212-663-4135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ANDUJAR
Title or Position: EMPLOYMENT SPECIALIST
Credential:
Phone: 212-663-3000