Basic Information
Provider Information | |||||||||
NPI: | 1366499444 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CITY OF NEW YORK OFFICE OF PAYROLL ADMINISTRATION | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NEW YORK CITY DEPT OF HEALTH & MENTAL HYGIENE RICHMOND | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 42-09 28TH STREET CN-48 | ||||||||
Address2: |   | ||||||||
City: | LONG ISLAND CITY | ||||||||
State: | NY | ||||||||
PostalCode: | 111014132 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3473966234 | ||||||||
FaxNumber: | 3473966366 | ||||||||
Practice Location | |||||||||
Address1: | 51 STUYVESANT PLACE | ||||||||
Address2: | NYCDOHMH RICHOMOND DHC | ||||||||
City: | STATEN ISLAND | ||||||||
State: | NY | ||||||||
PostalCode: | 103011912 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7189834502 | ||||||||
FaxNumber: | 7182738195 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/27/2006 | ||||||||
LastUpdateDate: | 05/03/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GIRALDO | ||||||||
AuthorizedOfficialFirstName: | MARITZA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | BILLING DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 3473966234 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | 7002112R1744 | NY | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
ID | Type | State | Issuer | Description | 00247521 | 05 | NY |   | MEDICAID |