Organization
ALBERT ENISTEIN COLLEGE OF MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATASHA GREEN (RN)
17189944901
Entity
Organization
Contact information
Practice address
1510 WATERS PL, BRONX, NY 10461-2700
(347) 493-8503
Mailing address
3704 SECOR AVE, BRONX, NY 10466-5917
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
952550787
NY
Other
Enumeration date
03/06/2014
Last updated
03/06/2014
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