MEDICARE: SERVICES FOR THE UNDERSERVED, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		NY

General Provider Information

NPI Number	:	1063868669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVICES FOR THE UNDERSERVED, INC

Provider Business Mailing Address
First Line	:	305 7TH AVE
Second Line	:	10TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10001-6008
Country	:	US
Telephone Number	:	917-408-1642
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 DECATUR ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2513
Country	:	US
Telephone Number	:	917-408-4642
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. PERRY PERLMUTTER
Credential	:
Telephone Number	:	646-565-5887

Provider Enumeration Date	:	05/12/2016
Last Update Date	:	05/12/2016

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