| Outreach Project | |
|
11711 Myrtle Avenue Richmond Hill NY 11418-1751 | |
| (718) 847-9233 | |
| (718) 849-1093 |
| Full Name | Outreach Project |
|---|---|
| Speciality | Counselor |
| Location | 11711 Myrtle Avenue, Richmond Hill, New York |
| Authorized Official Name and Position | Christine Casiano (VICE PRESIDENT OF OPERATIONS AND CO) |
| Authorized Official Contact | 7188479233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Outreach Project 11711 Myrtle Avenue Richmond Hill NY 11418 Ph: (718) 847-9233 | Outreach Project 11711 Myrtle Avenue Richmond Hill NY 11418-1751 Ph: (718) 847-9233 |
| NPI Number | 1083717326 |
|---|---|
| Provider Enumeration Date | 09/05/2006 |
| Last Update Date | 08/16/2021 |
| Certification Date | 08/16/2021 |
| Medicare PECOS PAC ID | 1355323270 |
|---|---|
| Medicare Enrollment ID | O20040603001529 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083717326 | NPI | - | NPPES |
| 00994803 | Medicaid | NY |
| Provider Name | Enoch C Chan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356309603 PECOS PAC ID: 3678558038 Enrollment ID: I20040621000604 |
| Provider Name | Jose Pugliese |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861434532 PECOS PAC ID: 7214993617 Enrollment ID: I20041207001153 |
| Provider Name | Laurie A Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104907187 PECOS PAC ID: 6709072754 Enrollment ID: I20101202000303 |
| Provider Name | Donna M Bornfriend |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619085537 PECOS PAC ID: 8426245507 Enrollment ID: I20101215000671 |
| Provider Name | Syed H Jaffery |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427184829 PECOS PAC ID: 5991981102 Enrollment ID: I20110523000529 |
| Provider Name | Margret M Slayback |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801062252 PECOS PAC ID: 5395048664 Enrollment ID: I20160120000871 |
| Provider Name | Pamela Zuccarelli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689112195 PECOS PAC ID: 7113201112 Enrollment ID: I20170310000223 |
| Provider Name | James Valinoti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245756154 PECOS PAC ID: 7315212008 Enrollment ID: I20171005002054 |
| Provider Name | Muhammad N Iqbal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609280262 PECOS PAC ID: 1658646831 Enrollment ID: I20181126003580 |
| Provider Name | Sindy Castro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184017014 PECOS PAC ID: 3173958683 Enrollment ID: I20200110000204 |
| Provider Name | Thomas J Olivo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255778213 PECOS PAC ID: 3375978364 Enrollment ID: I20200122000634 |
| Provider Name | Julio Angel Santiago |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912242512 PECOS PAC ID: 5890106967 Enrollment ID: I20201120000524 |
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