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NPI Code Detail

MEDICARE: SAMARITAN DAYTOP VILLAGE, INC.

MEDICARE: SAMARITAN DAYTOP VILLAGE, 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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/CenterNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
27002121ROTHERNYDEPT OF HEALTH ART 28 CER

General Provider Information

NPI Number : 1548381767
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAMARITAN DAYTOP VILLAGE, INC.
Provider Business Mailing Address
First Line : 54 W 40TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10018-2602
Country : US
Telephone Number : 212-354-6000
Fax Number : 212-382-3899
Provider Business Practice Location Address
First Line : 1915 FOREST AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10303-2127
Country : US
Telephone Number : 718-981-3136
Fax Number : 718-981-6849
Authorized Official
Title or Position : VP OF HEALTH SERVICES & COMMUNITY B
Name : CHARLES MADRAY
Credential : MBA
Telephone Number : 718-206-2000
Provider Enumeration Date : 04/03/2007
Last Update Date : 04/29/2016

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