Healthcare Provider Details

I. General information

NPI: 1285309849
Provider Name (Legal Business Name): AL ANDALUS COMMUNITY SERVICES OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 RICHMOND TER
STATEN ISLAND NY
10303-1303
US

IV. Provider business mailing address

19 MELBA ST
STATEN ISLAND NY
10314-5334
US

V. Phone/Fax

Practice location:
  • Phone: 646-339-1894
  • Fax:
Mailing address:
  • Phone: 646-339-1894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AHMAD HUSSEIN
Title or Position: CFO
Credential:
Phone: 646-339-1894