Healthcare Provider Details

I. General information

NPI: 1639882012
Provider Name (Legal Business Name): THE LENOX-UNIM COMMUNITY HEALTH INITIATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E 125TH ST
NEW YORK NY
10035-1685
US

IV. Provider business mailing address

51 E 125TH ST SUITE 3L
NEW YORK NY
10035-1685
US

V. Phone/Fax

Practice location:
  • Phone: 212-470-1465
  • Fax: 646-921-3189
Mailing address:
  • Phone: 212-470-1465
  • Fax: 646-470-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: BRANDON C JONES
Title or Position: COMMISSIONER, PRESIDENT, CASE MGR
Credential:
Phone: 646-585-1515