Basic Information
| Provider Information | |||||||||
| NPI: | 1508279902 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REALIZATION CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 REMSEN ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112014333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183426700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 175 REMSEN ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112014333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183426700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2014 | ||||||||
| LastUpdateDate: | 06/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | MOLINA | ||||||||
| AuthorizedOfficialFirstName: | WILDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CILNICAL SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 71834267000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.