| Prometheus Cdtp | |
|
402 E 156th St Bronx NY 10455-1232 | |
| (718) 993-3183 | |
| (718) 402-9622 |
| Full Name | Prometheus Cdtp |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 402 E 156th St, Bronx, New York |
| Authorized Official Name and Position | Daniel L Lowy (DIRECTOR, MANAGED CARE CONTRACTING) |
| Authorized Official Contact | 7184015650 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prometheus Cdtp 760 E 160th St Bronx NY 10456-7815 Ph: (718) 401-5700 | Prometheus Cdtp 402 E 156th St Bronx NY 10455-1232 Ph: (718) 993-3183 |
| NPI Number | 1710022330 |
|---|---|
| Provider Enumeration Date | 02/21/2007 |
| Last Update Date | 09/11/2023 |
| Certification Date | 09/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710022330 | NPI | - | NPPES |
| 01103593 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 7922300A (New York) | Primary |
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