Basic Information
| Provider Information | |||||||||
| NPI: | 1194861179 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LINCOLN MEDICAL MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 234 E 149TH ST 10-C | ||||||||
| Address2: | BRONX NEW YORK | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795000 | ||||||||
| FaxNumber: | 7185795284 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 E 149TH ST 10-C | ||||||||
| Address2: | BRONX NEW YORK | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795000 | ||||||||
| FaxNumber: | 7185795284 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CASTILLO | ||||||||
| AuthorizedOfficialFirstName: | SOCRATES | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHIATRIC RESIDENT LEVEL IV | ||||||||
| AuthorizedOfficialTelephone: | 7185795000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | SR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | Y | Hospitals | Psychiatric Hospital |
No ID Information.