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General NPI Number Information
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NPI Number | 1134593510
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Entity Type | Organization
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Legal Business Name | REVCORE RECOVERY CENTER OF MANHATTAN, LLC
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 394 BROADWAY FL 4
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City | NEW YORK
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State | NY
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Zip | 10013-6023
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Country | US
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Telephone | 212-966-9537
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Fax |
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Provider Business Mailing Address
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Address Line | 394 BROADWAY FL 4
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City | NEW YORK
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State | NY
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Zip | 10013-6023
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Country | US
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Telephone | 212-966-9537
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AVRAHAM SCHICK
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Credential |
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Telephone | 917-743-6302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 161011950
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 161011950
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License Number State | NY
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