Basic Information
Provider Information | |||||||||
NPI: | 1770885451 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THE GUIDANCE CENTER CDTC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 20 SICKLES AVE | ||||||||
Address2: |   | ||||||||
City: | NEW ROCHELLE | ||||||||
State: | NY | ||||||||
PostalCode: | 108014030 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9146321374 | ||||||||
FaxNumber: | 9146322217 | ||||||||
Practice Location | |||||||||
Address1: | 20 SICKLES AVE | ||||||||
Address2: |   | ||||||||
City: | NEW ROCHELLE | ||||||||
State: | NY | ||||||||
PostalCode: | 108014030 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9146321374 | ||||||||
FaxNumber: | 9146322217 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/01/2010 | ||||||||
LastUpdateDate: | 12/01/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CHOE | ||||||||
AuthorizedOfficialFirstName: | JINHOON | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 9146321374 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | THE GUIDANCE CENTER INC. | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MEDICAL DOCTOR | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2800X | 536603 | NY | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.