# EATING DISORDER TREATMENT OF NEW YORK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clementine North Shore
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699528950
- **Authorized official:** JASON SCHULZ (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (720) 440-4277

## Contact information

- **Practice address:** 254 BREAD AND CHEESE HOLLOW RD, NORTHPORT, NY 11768-2606
- **Practice address phone:** (631) 540-0980
- **Practice address fax:** (631) 967-1667
- **Mailing address:** 6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
- **Mailing address phone:** (305) 663-1876
- **Mailing address fax:** (786) 359-4485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/08/2024
- **Last updated:** 06/05/2025