Basic Information
| Provider Information | |||||||||
| NPI: | 1497942114 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK CENTER FOR ADDICTION TREATMENT SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 598 BROADWAY | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100123225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129669537 | ||||||||
| FaxNumber: | 2125845450 | ||||||||
| Practice Location | |||||||||
| Address1: | 598 BROADWAY | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100123225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129669537 | ||||||||
| FaxNumber: | 2125845450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2007 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | KRAMER | ||||||||
| AuthorizedOfficialFirstName: | EVERETT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2129669537 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 060310892 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 01492644 | 05 | NY | MEDICAID |