Provider Demographics
NPI:1205183191
Name:HARLEM EAST LIFE PLAN
Entity Type:Organization
Organization Name:HARLEM EAST LIFE PLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BISHME
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:212-876-2300
Mailing Address - Street 1:2367-69 SECOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035
Mailing Address - Country:US
Mailing Address - Phone:212-876-2300
Mailing Address - Fax:
Practice Address - Street 1:2367-69 SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-876-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SES OPERATING CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-09
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 083220251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health