Provider Demographics
NPI:1033305891
Name:ADULT CARE SERVICES
Entity Type:Organization
Organization Name:ADULT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-918-3669
Mailing Address - Street 1:1400 PELHAM PKWY S
Mailing Address - Street 2:6 A CLINIC, BUILDING 5, 6TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1138
Mailing Address - Country:US
Mailing Address - Phone:718-918-4331
Mailing Address - Fax:718-918-7686
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:6 A CLINIC, BUILDING 5, 6TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-4331
Practice Address - Fax:718-918-7686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QM0801X261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)