Basic Information
| Provider Information | |||||||||
| NPI: | 1972932465 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REALIZATION CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 UNION SQ W | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100033304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126279600 | ||||||||
| FaxNumber: | 2126274040 | ||||||||
| Practice Location | |||||||||
| Address1: | 19 UNION SQ W | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100033304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126279600 | ||||||||
| FaxNumber: | 2126274040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2013 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | SHATULINA | ||||||||
| AuthorizedOfficialFirstName: | NATALIA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2126279600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BS, AOS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 89756 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.