Organization
RICHMOND UNIVERSITY MEDICAL CENTER ADOLESCENT PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT REN (AVP FINANCE)
(718) 818-1380
Entity
Organization
Contact information
Practice address
669 CASTLETON AVE, STATEN ISLAND, NY 10301-2028
(718) 442-2225
(718) 442-2289
Mailing address
669 CASTLETON AVE, STATEN ISLAND, NY 10301-2028
(718) 442-2225
(718) 442-2289
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
7749004A
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00248820
—
NY
Enumeration date
07/31/2015
Last updated
07/31/2015
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