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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN SAULTERS (OWNER)
(347) 218-1105
Entity
Organization

Contact information

Practice address
452 MADISON ST APT 1B, BROOKLYN, NY 11221-1142
(347) 218-1105
Mailing address
452 MADISON ST APT 1B, BROOKLYN, NY 11221-1142
(347) 218-1105

Taxonomy

Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
251B00000X
Case Management Agency
251K00000X
Public Health or Welfare Agency
251S00000X
Community/Behavioral Health Agency
251V00000X
Voluntary or Charitable Agency
261QC1500X
Community Health Clinic/Center
261QH0100X
Health Service Clinic/Center
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
261QP3300X
Pain Clinic/Center
Primary

Other

Enumeration date
11/14/2017
Last updated
11/14/2017
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