Basic Information
| Provider Information | |||||||||
| NPI: | 1700263175 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK CENTER FOR ADDICTION TREATMENT SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 598 BROADWAY FL 2 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100123363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129669537 | ||||||||
| FaxNumber: | 2125845450 | ||||||||
| Practice Location | |||||||||
| Address1: | 3720 74TH ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | JACKSON HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113726338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184266222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2015 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | KRAMER | ||||||||
| AuthorizedOfficialFirstName: | EVERETT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9148829652 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEW YORK CENTER FOR ADDICTION TREATMENT SERVICES, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 160411881 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 160411881 | 01 | NY | OASAS | OTHER |