Provider Demographics
NPI:1114304458
Name:SUS
Entity Type:Organization
Organization Name:SUS
Other - Org Name:PALLADIA, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIERBICKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:212-722-7507
Mailing Address - Street 1:170 E 107TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3905
Mailing Address - Country:US
Mailing Address - Phone:212-722-7507
Mailing Address - Fax:212-722-7583
Practice Address - Street 1:170 E 107TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3905
Practice Address - Country:US
Practice Address - Phone:212-722-7507
Practice Address - Fax:212-722-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150511551324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility