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General NPI Number Information
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NPI Number | 1447529474
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Entity Type | Organization
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Legal Business Name | NEW YORK CENTER OF ADDICTION LLC
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 506 WILLIS AVENUE 7TH FLOOR
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City | BRONX
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State | NY
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Zip | 10455
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Country | US
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Telephone | 347-641-5406
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Fax |
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Provider Business Mailing Address
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Address Line | 124 EAST 177TH STREET SUITE 6C BRONX COUNTY
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City | BRONX
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State | NY
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Zip | 10453
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Country | US
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Telephone | 917-529-5806
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | YOLANDA CRUZ
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Credential | MPA
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Telephone | 917-529-5806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 232661-1
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License Number State | NY
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