Healthcare Provider Details

I. General information

NPI: 1477295848
Provider Name (Legal Business Name): THE DERECH SHALOM CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MONTEBELLO RD
SUFFERN NY
10901-3746
US

IV. Provider business mailing address

75 MONTEBELLO RD
SUFFERN NY
10901-3746
US

V. Phone/Fax

Practice location:
  • Phone: 845-523-9300
  • Fax:
Mailing address:
  • Phone: 845-523-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AVI KAHAN
Title or Position: FOUNDER AND PRESIDENT
Credential:
Phone: 845-523-9300