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General NPI Number Information
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NPI Number | 1225414329
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Entity Type | Organization
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Legal Business Name | RICHMOND UNIVERSITY MEDICAL CENTER ADOLESCENT PROGRAM
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 669 CASTLETON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2028
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Country | US
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Telephone | 718-442-2225
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Fax | 718-442-2289
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Provider Business Mailing Address
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Address Line | 669 CASTLETON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301-2028
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Country | US
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Telephone | 718-442-2225
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Fax | 718-442-2289
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Authorized Official
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Title or Position | AVP FINANCE
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Name | MR. ROBERT REN
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Credential |
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Telephone | 718-818-1380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 7749004A
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License Number State | NY
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