Basic Information
| Provider Information | |||||||||
| NPI: | 1932444197 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CANARSIE AWARE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1285 ROCKAWAY AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112362330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182573195 | ||||||||
| FaxNumber: | 7182571162 | ||||||||
| Practice Location | |||||||||
| Address1: | 1285 ROCKAWAY AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112362330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182573195 | ||||||||
| FaxNumber: | 7182571162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2012 | ||||||||
| LastUpdateDate: | 11/29/2012 | ||||||||
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| AuthorizedOfficialLastName: | CORNACHIO | ||||||||
| AuthorizedOfficialFirstName: | TONY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7182573195 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 655262-1 | NY | Y | Agencies | Community/Behavioral Health |
No ID Information.