MEDICARE: NIFKAB

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1952600348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIFKAB

Provider Business Mailing Address
First Line	:	POST OFFICE BOX 60725
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-0725
Country	:	US
Telephone Number	:	718-815-3500
Fax Number	:	718-760-6064

Provider Business Practice Location Address
First Line	:	981 BAY ST
Second Line	:	SUITE NUMBER 6
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4903
Country	:	US
Telephone Number	:	718-815-3500
Fax Number	:	718-764-6064

Authorized Official
Title or Position	:	SVP
Name	:	MR. KEITH BARR
Credential	:
Telephone Number	:	516-351-4884

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/25/2011

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