| Bridge Back To Life Center, Inc. | |
|
1688 Victory Blvd Staten Island NY 10314-3547 | |
| (718) 447-5700 | |
| (718) 442-8945 |
| Full Name | Bridge Back To Life Center, Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1688 Victory Blvd, Staten Island, New York |
| Authorized Official Name and Position | Gary Butchen (PRESIDENT) |
| Authorized Official Contact | 5165206600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Back To Life Center, Inc. 4271 Hempstead Tpke Bethpage NY 11714-5708 Ph: (516) 520-6600 | Bridge Back To Life Center, Inc. 1688 Victory Blvd Staten Island NY 10314-3547 Ph: (718) 447-5700 |
| NPI Number | 1790102051 |
|---|---|
| Provider Enumeration Date | 03/25/2014 |
| Last Update Date | 11/07/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790102051 | NPI | - | NPPES |
| 01439087 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 141110677 (New York) | Primary |
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