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General NPI Number Information
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NPI Number | 1528108974
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Entity Type | Organization
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Legal Business Name | GOUVERNEUR HEALTHCARE SERVICES
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 227 MADISON ST PHARMACY FIRST FLOOR
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City | NEW YORK
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State | NY
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Zip | 10002-7537
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Country | US
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Telephone | 212-238-7071
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Fax | 212-238-7009
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Provider Business Mailing Address
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Address Line | 227 MADISON ST PHARMACY FIRST FLOOR
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City | NEW YORK
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State | NY
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Zip | 10002-7537
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Country | US
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Telephone | 212-238-7071
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Fax | 212-238-7009
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MISS MENDEL HAGLER
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Credential | ESQ.,
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Telephone | 212-238-7663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0301112
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License Number State | NY
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