Organization
PROJECT RENEWAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LECK DZIE (DATABASE ADMINISTRATOR)
(212) 620-0340
Entity
Organization
Contact information
Practice address
200 VARICK ST, NEW YORK, NY 10014-4810
(212) 620-0340
(212) 633-1410
Mailing address
200 VARICK ST, NEW YORK, NY 10014-4810
(212) 620-0340
(212) 633-1410
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00245267
—
NY
Enumeration date
08/01/2006
Last updated
02/17/2022
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