Basic Information
| Provider Information | |||||||||
| NPI: | 1639400153 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NYCHHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 78 MIDLAND AVE | ||||||||
| Address2: | PRIVATE HOUSE | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107052733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147511332 | ||||||||
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| Practice Location | |||||||||
| Address1: | 234 EUGENIO MARIA DE HOSTO BLVD | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795657 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2010 | ||||||||
| LastUpdateDate: | 01/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | VAZQUEZ | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | SOCIAL WORKER IV | ||||||||
| AuthorizedOfficialTelephone: | 7185794628 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 070779-1 | NY | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 55PHH785362 | 01 | NY | CAR INSURANCE | OTHER |