Provider Demographics
NPI:1083852933
Name:MARTIN LUTHER KING ADDICTIVE DISEASE SERVICES
Entity Type:Organization
Organization Name:MARTIN LUTHER KING ADDICTIVE DISEASE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-518-3700
Mailing Address - Street 1:321 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5304
Mailing Address - Country:US
Mailing Address - Phone:718-518-3700
Mailing Address - Fax:718-294-6999
Practice Address - Street 1:321 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5304
Practice Address - Country:US
Practice Address - Phone:718-518-3700
Practice Address - Fax:718-294-6999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRONX LEBANON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital