Organization
SAMARITAN VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES MADRAY (VP OF HEALTH SERVICES & COMMUNITY B)
(718) 206-2000
Entity
Organization
Contact information
Practice address
528 MORRIS AVE, BRONX, NY 10451
(718) 292-4640
Mailing address
138-02 QUEENS BLVD, BRIARWOOD, NY 11435
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00245309
—
NY
Enumeration date
10/28/2015
Last updated
04/29/2016
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