Provider Demographics
NPI:1063682623
Name:PROTESTANT BOARD OF GUARDIANS INC
Entity Type:Organization
Organization Name:PROTESTANT BOARD OF GUARDIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:718-636-8103
Mailing Address - Street 1:1368 FULTON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2635
Mailing Address - Country:US
Mailing Address - Phone:718-636-8103
Mailing Address - Fax:718-636-8616
Practice Address - Street 1:1368 FULTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2635
Practice Address - Country:US
Practice Address - Phone:718-636-8103
Practice Address - Fax:718-636-8616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02376887Medicaid