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General NPI Number Information
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NPI Number | 1679517775
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Entity Type | Organization
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Legal Business Name | NYCDOHMH BUR MATERN CONNECT FAC
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2 LAFAYETTE STREET BOX 34A 18TH FLOOR NYCDOHMH BUR MATERN CONNECT FAC
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City | NEW YORK
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State | NY
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Zip | 10007-1322
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Country | US
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Telephone | 212-442-1740
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Fax | 212-442-1789
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Provider Business Mailing Address
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Address Line | 125 WORTH STREET BOX 74 RM 901 NYCDOHMH DIVISION OF DISEASE CONTROL
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City | NEW YORK
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State | NY
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Zip | 10013-4006
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Country | US
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Telephone | 212-442-8468
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Fax | 212-442-8452
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Authorized Official
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Title or Position | ADMINISTRATIVE MANAGER THIRD PARTY
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Name | MR. MICHAEL JAMES SMOOK
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Credential | MPA
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Telephone | 212-442-8468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 01214617026
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License Number State | NY
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