Basic Information
| Provider Information | |||||||||
| NPI: | 1346232345 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY SETTLEMENT SOCIETY OF NEW YORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 184 ELDRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100022924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124534505 | ||||||||
| FaxNumber: | 2127770445 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 ELDRIDGE ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100022924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126749120 | ||||||||
| FaxNumber: | 2122545334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2124534522 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 00243930 | 05 | NY | MEDICAID |