| Bridge Back To Life Center, Inc. | |
|
1065 Stewart Ave Ste 101 Bethpage NY 11714-3637 | |
| (516) 520-6600 | |
| (516) 520-6750 |
| Full Name | Bridge Back To Life Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1065 Stewart Ave Ste 101, Bethpage, New York |
| Authorized Official Name and Position | Elizabeth Carucci Rossi (BILLING SUPERVISOR) |
| Authorized Official Contact | 5165206600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Back To Life Center, Inc. 1065 Stewart Ave Ste 101 Bethpage NY 11714-3637 Ph: (516) 520-6600 | Bridge Back To Life Center, Inc. 1065 Stewart Ave Ste 101 Bethpage NY 11714-3637 Ph: (516) 520-6600 |
| NPI Number | 1518918101 |
|---|---|
| Provider Enumeration Date | 05/16/2006 |
| Last Update Date | 07/22/2024 |
| Certification Date | 07/22/2024 |
| Medicare PECOS PAC ID | 0941191399 |
|---|---|
| Medicare Enrollment ID | O20081202000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518918101 | NPI | - | NPPES |
| Provider Name | Gary A Butchen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649357468 PECOS PAC ID: 3072549328 Enrollment ID: I20050708000894 |
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