Basic Information
Provider Information | |||||||||
NPI: | 1780319426 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CATHOLIC CHARITIES NEIGHBORHOOD SERVICES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 191 JORALEMON STREET | ||||||||
Address2: | 6TH FLOOR | ||||||||
City: | BROOKLYN | ||||||||
State: | NY | ||||||||
PostalCode: | 112014306 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7187226230 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 16110 JAMAICA AVE FL 2 | ||||||||
Address2: |   | ||||||||
City: | JAMAICA | ||||||||
State: | NY | ||||||||
PostalCode: | 114326139 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9293972620 | ||||||||
FaxNumber: | 9293972621 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/18/2022 | ||||||||
LastUpdateDate: | 07/18/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BARBERIO | ||||||||
AuthorizedOfficialFirstName: | DESIREE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP CARE COORDINATION & CASE MGMNT. | ||||||||
AuthorizedOfficialTelephone: | 7187226000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | CATHOLIC CHARITIES NEIGHBORHOOD SERVICES, INC. | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/18/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center |   |
No ID Information.