=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063950418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE NEW YORK MILK BANK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2017
-----------------------------------------------------
Last Update Date | 02/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 OLD BROADWAY
-----------------------------------------------------
City | HASTINGS ON HUDSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10706-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-956-6455
-----------------------------------------------------
Fax | 914-471-9703
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 OLD BROADWAY
-----------------------------------------------------
City | HASTINGS ON HUDSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10706-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-956-6455
-----------------------------------------------------
Fax | 914-471-9703
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. JULIE BOUCHET-HORWITZ
-----------------------------------------------------
Credential | FNP-BC
-----------------------------------------------------
Telephone | 212-956-5455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number | HM019
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------