Provider Demographics
NPI:1164453312
Name:SLR PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:SLR PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-523-2965
Mailing Address - Street 1:1090 AMSTERDAM AVE
Mailing Address - Street 2:SUITE 16C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1737
Mailing Address - Country:US
Mailing Address - Phone:212-523-2965
Mailing Address - Fax:212-636-1303
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:SUITE 16C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-523-2965
Practice Address - Fax:212-636-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01540798Medicaid
NY01540798Medicaid