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General NPI Number Information
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NPI Number | 1821826652
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND PERFORMING PROVIDER SYSTEM LLC
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Dates
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Enumeration Date | 07/23/2024
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 1 EDGEWATER ST STE 700
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4902
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Country | US
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Telephone | 917-830-1141
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Fax |
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Provider Business Mailing Address
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Address Line | 1 EDGEWATER ST STE 700
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4902
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Country | US
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Telephone | 917-830-1141
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. JOSEPH CONTE
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Credential | PHD
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Telephone | 917-830-1141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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