Organization
BRIDGE BACK TO LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT J. VIGIL CASAC (COUNSELOR)
(212) 679-4960
Entity
Organization
Contact information
Practice address
500 8TH AVE RM 906, NEW YORK, NY 10018-4190
(212) 679-4960
Mailing address
500 8TH AVE RM 906, NEW YORK, NY 10018-4190
(212) 679-4960
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
17584
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17584
CASAC
NY
Enumeration date
11/23/2009
Last updated
11/23/2009
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