Provider Demographics
NPI:1235696337
Name:TRIUMPH TREATMENT LLC
Entity Type:Organization
Organization Name:TRIUMPH TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:REBENWURZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-854-5400
Mailing Address - Street 1:309 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3241
Mailing Address - Country:US
Mailing Address - Phone:516-854-5400
Mailing Address - Fax:
Practice Address - Street 1:309 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3241
Practice Address - Country:US
Practice Address - Phone:516-854-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty