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General NPI Number Information
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NPI Number | 1821263633
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Entity Type | Organization
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Legal Business Name | WESTON UNITED
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 09/30/2009
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Provider Practice Location Address
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Address Line | 321 W 125TH ST
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City | NEW YORK
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State | NY
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Zip | 10027-3637
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Country | US
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Telephone | 212-866-6040
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Fax | 212-866-9693
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Provider Business Mailing Address
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Address Line | 321 WEST 125 STREET
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City | NEW YORK
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State | NY
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Zip | 10027
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Country | US
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Telephone | 212-866-6040
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. JEAN NEWBURG
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Credential |
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Telephone | 212-866-6040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 02187286
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License Number State | NY
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