Provider Demographics
NPI:1104035484
Name:ADDICTION RESEACH TREATMENT CORP.
Entity Type:Organization
Organization Name:ADDICTION RESEACH TREATMENT CORP.
Other - Org Name:FORT GREEN RISE.
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMO
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:1718-636-0015
Mailing Address - Street 1:151 NORMAN AVE.
Mailing Address - Street 2:APT 2L
Mailing Address - City:NYC
Mailing Address - State:NJ
Mailing Address - Zip Code:11222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:937 FULTON ST.
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:11238
Practice Address - Country:US
Practice Address - Phone:171-863-6001
Practice Address - Fax:718-638-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health