| Icl-east New York Prevention-based Satellite | |
|
40 Rector St Fl 11 New York NY 10006-1705 | |
| (212) 385-3030 | |
| Not Available |
| Full Name | Icl-east New York Prevention-based Satellite |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 40 Rector St Fl 11, New York, New York |
| Authorized Official Name and Position | Dewey Howard (C F O) |
| Authorized Official Contact | 2123853030 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icl-east New York Prevention-based Satellite 350 Linwood St Brooklyn NY 11208-2116 Ph: () - | Icl-east New York Prevention-based Satellite 40 Rector St Fl 11 New York NY 10006-1705 Ph: (212) 385-3030 |
| NPI Number | 1902054943 |
|---|---|
| Provider Enumeration Date | 09/03/2008 |
| Last Update Date | 09/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902054943 | NPI | - | NPPES |
| 7720101B | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 7720101B (New York) | Primary |
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