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General NPI Number Information
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NPI Number | 1588077655
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Entity Type | Organization
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Legal Business Name | 820 RIVER STREET
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 06/06/2014
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Provider Practice Location Address
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Address Line | 10830 SUTPHIN BLVD
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City | JAMAICA
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State | NY
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Zip | 11435-5444
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Country | US
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Telephone | 718-526-3803
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Fax | 718-526-3908
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Provider Business Mailing Address
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Address Line | 10830 SUTPHIN BLVD
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City | JAMAICA
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State | NY
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Zip | 11435-5444
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Country | US
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Telephone | 718-526-3803
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Fax | 718-526-3908
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Authorized Official
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Title or Position | OFICE MANAGER
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Name | MS. ELIZABETH VASQUEZ
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Credential |
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Telephone | 718-526-3803
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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 |
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License Number State | NY
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