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General NPI Number Information
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NPI Number | 1114213824
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Entity Type | Organization
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Legal Business Name | GOTHAM
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 116 JOHN ST.
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City | NEW YORK
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State | NY
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Zip | 10038-3414
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Country | US
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Telephone | 212-385-0086
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Fax |
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Provider Business Mailing Address
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Address Line | 135 WATKINS ST
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City | BROOKLYN
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State | NY
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Zip | 11212-6712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARGARET GOLDEN
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Credential |
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Telephone | 212-477-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | 641372
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License Number State | NY
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