Provider Demographics
NPI:1235387309
Name:INTERFAITH MEDICAL CENTER
Entity Type:Organization
Organization Name:INTERFAITH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CUTELLE
Authorized Official - Middle Name:HYACINTH
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-612-7264
Mailing Address - Street 1:19714 120TH AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3700
Mailing Address - Country:US
Mailing Address - Phone:718-525-1451
Mailing Address - Fax:718-525-4204
Practice Address - Street 1:1475 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2506
Practice Address - Country:US
Practice Address - Phone:718-613-7264
Practice Address - Fax:718-613-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071847-1261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health