MEDICARE: NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE

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	251300000X	Local Education Agency (LEA)
2	252Y00000X	Early Intervention Provider Agency		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194941120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE

Provider Business Mailing Address
First Line	:	4209 28TH ST # CN-48
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4130
Country	:	US
Telephone Number	:	347-396-6299
Fax Number	:	347-396-6367

Provider Business Practice Location Address
First Line	:	4209 28TH ST # CN-48
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-4130
Country	:	US
Telephone Number	:	347-396-6299
Fax Number	:	347-396-6367

Authorized Official
Title or Position	:	DIRECTOR OF PATIENT BILLING
Name	:	JANET ELLIS
Credential	:
Telephone Number	:	347-396-6299

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	09/25/2023

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