=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548635774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPONENTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2015
-----------------------------------------------------
Last Update Date | 12/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 WASHINGTON ST 4TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10004-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-243-3434
-----------------------------------------------------
Fax | 212-243-1257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 WASHINGTON ST 4TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10004-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-243-3434
-----------------------------------------------------
Fax | 212-243-1257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. HOWARD JOSEPHER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 212-243-3434
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number | C150910773
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------