=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528443074
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIA DYCKMAN ANDRUS MEMORIAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2015
-----------------------------------------------------
Last Update Date | 07/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1156 N BROADWAY
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-965-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1156 N BROADWAY
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10701-1108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-965-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BRYAN MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-965-3700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0864791
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------