Basic Information
| Provider Information | |||||||||
| NPI: | 1699310292 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATHOLIC CHARITIES NEIGBORHOOD SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 191 JORALEMON ST FL 11 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112014353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187226000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9114 MERRICK BLVD FL 6 | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114325363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186746066 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2019 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | WOLINETZ | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7187226130 | ||||||||
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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 | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 02704052 | 05 | NY | MEDICAID |