Organization
820 RIVER STREET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELIZABETH VASQUEZ (OFICE MANAGER)
(718) 526-3803
Entity
Organization
Contact information
Practice address
10830 SUTPHIN BLVD, JAMAICA, NY 11435-5444
(718) 526-3803
(718) 526-3908
Mailing address
10830 SUTPHIN BLVD, JAMAICA, NY 11435-5444
(718) 526-3803
(718) 526-3908
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01137159
—
NY
Enumeration date
06/06/2014
Last updated
06/06/2014
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