Provider Demographics
NPI:1073938486
Name:NYC DOHMH DEPARTMENT OF SCHOOL HEATH
Entity Type:Organization
Organization Name:NYC DOHMH DEPARTMENT OF SCHOOL HEATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-396-4718
Mailing Address - Street 1:2936 214TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2816
Mailing Address - Country:US
Mailing Address - Phone:718-352-6507
Mailing Address - Fax:
Practice Address - Street 1:7510 21ST AVE
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1121
Practice Address - Country:US
Practice Address - Phone:718-728-1459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY566260-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9175667465Medicaid