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General NPI Number Information
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NPI Number | 1720344120
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Entity Type | Organization
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Legal Business Name | COORDINATED BEHAVIORAL CARE, INC
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 12/12/2018
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Provider Practice Location Address
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Address Line | 40 RECTOR ST 11TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10006-1705
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Country | US
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Telephone | 212-385-3030
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Fax | 212-619-7275
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Provider Business Mailing Address
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Address Line | 123 WILLIAM STREET 19TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10038
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Country | US
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Telephone | 646-930-8803
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Fax | 212-619-7275
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | JORGE R PETIT
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Credential | MD
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Telephone | 636-930-8803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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