Healthcare Provider Details

I. General information

NPI: 1316350788
Provider Name (Legal Business Name): ESPERANZA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 E 107TH ST
NEW YORK NY
10029-3905
US

IV. Provider business mailing address

2006 MADISON AVE
NEW YORK NY
10035-1217
US

V. Phone/Fax

Practice location:
  • Phone: 212-722-7507
  • Fax: 212-722-7583
Mailing address:
  • Phone: 212-979-8800
  • Fax: 212-979-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MARK HURWITZ
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 212-979-8800