| Acdp | |
|
3940 Broadway Fl 2 New York NY 10032 | |
| (212) 781-5500 | |
| (212) 927-6089 |
| Full Name | Acdp |
|---|---|
| Speciality | Clinic/Center |
| Location | 3940 Broadway Fl 2, New York, New York |
| Authorized Official Name and Position | Vicky Gatell (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7189607629 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Acdp 311 E 175th St Bronx NY 10457-5859 Ph: (718) 960-7568 | Acdp 3940 Broadway Fl 2 New York NY 10032 Ph: (212) 781-5500 |
| NPI Number | 1629149125 |
|---|---|
| Provider Enumeration Date | 11/13/2006 |
| Last Update Date | 09/23/2022 |
| Certification Date | 09/23/2022 |
| Medicare PECOS PAC ID | 2264412816 |
|---|---|
| Medicare Enrollment ID | O20040723000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629149125 | NPI | - | NPPES |
| 01962550 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 8819100A (New York) | Primary |
| Provider Name | Yuberkys Cabrera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477808103 PECOS PAC ID: 8426289331 Enrollment ID: I20140318000726 |
| Provider Name | Dongjin Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811447501 PECOS PAC ID: 3274897244 Enrollment ID: I20180430001357 |
| Provider Name | Kenia Alcantara |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760012389 PECOS PAC ID: 8224465372 Enrollment ID: I20200302000873 |
| Provider Name | Merari K Vasquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982148250 PECOS PAC ID: 0648684720 Enrollment ID: I20210201002175 |
| Provider Name | William Tarrant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871677922 PECOS PAC ID: 7012383706 Enrollment ID: I20221020002734 |
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