Organization
REBORN FOR NEW LIFE LLC
Active
Organization
REBORN FOR NEW LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILKINS WILLIAMS (MEDICAL DIRECTOR)
(917) 553-0982
Entity
Organization
Contact information
Practice address
400 LIBERTY AVE, BROOKLYN, NY 11207-3032
(646) 251-1400
Mailing address
400 LIBERTY AVE, BROOKLYN, NY 11207-3032
(646) 251-1400
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
150211831
NY
261QH0100X
Health Service Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
150211831
OASAS
NY
Enumeration date
03/14/2014
Last updated
04/01/2014
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