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General NPI Number Information
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NPI Number | 1104176395
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Entity Type | Organization
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Legal Business Name | DEPARTEMENT OF HEALTH AND MENTAL HYGIENE
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 3433 JUNCTION BLVD
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-3828
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Country | US
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Telephone | 718-476-7636
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Fax | 718-476-7131
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Provider Business Mailing Address
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Address Line | 3433 JUNCTION BLVD
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-3828
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Country | US
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Telephone | 718-476-7636
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Fax | 718-476-7131
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Authorized Official
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Title or Position | PATIENT CARE MANAGER
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Name | MR. JOHN CABAN
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Credential | RN
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Telephone | 718-476-7123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 545218-1
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License Number State | NY
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