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General NPI Number Information
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NPI Number | 1215543376
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Entity Type | Organization
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Legal Business Name | CENTRAL PARK RECOVERY
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 2176 CENTRAL PARK AVE
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City | YONKERS
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State | NY
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Zip | 10710-1826
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Country | US
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Telephone | 914-447-6153
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 356
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City | YONKERS
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State | NY
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Zip | 10710-0356
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Country | US
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Telephone | 914-619-5242
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Fax |
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Authorized Official
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Title or Position | CEO/CLINICAL DIRECTOR
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Name | NICOLE INTERVALLO
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Credential | CASAC
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Telephone | 914-619-5242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State |
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