Organization
25 CHAPEL STREET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORIN BLAKE (CLINICAL DIRECTOR)
(718) 398-0153
Entity
Organization
Contact information
Practice address
25 CHAPEL ST, SUITE 901, BROOKLYN, NY 11201-1952
(718) 398-0153
Mailing address
301 W 130TH ST, APT 3C, NEW YORK, NY 10027-1813
(646) 542-3980
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
094063
NY
Other
Enumeration date
03/30/2016
Last updated
03/30/2016
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