Provider Demographics
NPI:1275880817
Name:DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT CAR MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-476-7636
Mailing Address - Street 1:3433 JUNCTION BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3828
Mailing Address - Country:US
Mailing Address - Phone:718-476-7636
Mailing Address - Fax:
Practice Address - Street 1:3433 JUNCTION BOULEVARD
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3828
Practice Address - Country:US
Practice Address - Phone:718-476-7636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494583-1251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare