Healthcare Provider Details

I. General information

NPI: 1790884500
Provider Name (Legal Business Name): DAYTOP VILLAGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WEST 40TH STREET 4TH FLOOR
NEW YORK NY
10018
US

IV. Provider business mailing address

104 WEST 40TH STREET 4TH FLOOR
NEW YORK NY
10018
US

V. Phone/Fax

Practice location:
  • Phone: 212-354-6000
  • Fax: 212-302-4051
Mailing address:
  • Phone: 212-354-6000
  • Fax: 212-302-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number070211238
License Number StateNY

VIII. Authorized Official

Name: MR. PAUL BURNS
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 212-354-6000