Healthcare Provider Details

I. General information

NPI: 1508317561
Provider Name (Legal Business Name): YMCA OF GREATER NY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 RICHMOND AVE
STATEN ISLAND NY
10312-5110
US

IV. Provider business mailing address

3911 RICHMOND AVE
STATEN ISLAND NY
10312-5110
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-3232
  • Fax: 718-966-6605
Mailing address:
  • Phone: 718-984-3232
  • Fax: 718-984-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number628518
License Number StateNY

VIII. Authorized Official

Name: MR. JOSEPH MICHEAL VERHEY
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential: LCSW,CASAC
Phone: 718-948-3232