Organization
UNDER 21
Active
Other names
Covenant House
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J DAVIS D.O. (MEDICAL DIRECTOR)
(212) 613-0300
Entity
Organization
Contact information
Practice address
460 W 41ST, NEW YORK, NY 10036
(212) 613-0300
(212) 268-2832
Mailing address
460 W 41ST, NEW YORK, NY 10036
(212) 613-0300
(212) 268-2832
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00733826
—
NY
Enumeration date
05/09/2008
Last updated
06/09/2017
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