| Samaritan Daytop Village, Inc. | |
|
2780 3rd Avenue Bronx NY 10455 | |
| (718) 292-4640 | |
| Not Available |
| Full Name | Samaritan Daytop Village, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 2780 3rd Avenue, Bronx, New York |
| Authorized Official Name and Position | Charles Madray (VP OF HEALTH SERVICES & COMM. BASED) |
| Authorized Official Contact | 7182062000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samaritan Daytop Village, Inc. 138-02 Queens Blvd Briarwood NY 11435 Ph: () - | Samaritan Daytop Village, Inc. 2780 3rd Avenue Bronx NY 10455 Ph: (718) 292-4640 |
| NPI Number | 1629440888 |
|---|---|
| Provider Enumeration Date | 10/28/2015 |
| Last Update Date | 04/13/2016 |
| Medicare PECOS PAC ID | 8123242906 |
|---|---|
| Medicare Enrollment ID | O20161004000379 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629440888 | NPI | - | NPPES |
| 00245309 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Adaiah T Lassalle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871647131 PECOS PAC ID: 9537143144 Enrollment ID: I20040614000210 |
| Provider Name | Gregory Charles Bunt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1063420057 PECOS PAC ID: 0244246924 Enrollment ID: I20060306000148 |
| Provider Name | Reza Taghavi Ardakany |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104085356 PECOS PAC ID: 3678716214 Enrollment ID: I20130829000041 |
| Provider Name | Maria Madrinan Kargman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568771277 PECOS PAC ID: 7911136015 Enrollment ID: I20140213000971 |
| Provider Name | Ivette Taveras Ozoria |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205206562 PECOS PAC ID: 0941505655 Enrollment ID: I20160217002220 |
| Provider Name | Muftau G Bello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932509767 PECOS PAC ID: 3577823194 Enrollment ID: I20180130001860 |
| Provider Name | Betty Ann Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073101499 PECOS PAC ID: 9234503285 Enrollment ID: I20230315000485 |
| Provider Name | Cherman E Pierre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821447608 PECOS PAC ID: 9436525573 Enrollment ID: I20230622000287 |
| Provider Name | Janice Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497455265 PECOS PAC ID: 2567817646 Enrollment ID: I20231010000903 |
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