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General NPI Number Information
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NPI Number | 1588180616
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Entity Type | Organization
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Legal Business Name | EATING DISORDER TREATMENT OF NEW YORK, LLC
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 222 BLOOMINGDALE RD
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City | WHITE PLAINS
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State | NY
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Zip | 10605-1513
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Country | US
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Telephone | 914-294-3404
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 SW 76TH ST
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5002
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Country | US
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Telephone | 305-663-1876
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JASON SCHULTZ
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Credential |
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Telephone | 720-440-4277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | NY
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