Provider Demographics
NPI:1306867593
Name:PAUL J COOPER CENTER FOR HUMAN SERVICES
Entity Type:Organization
Organization Name:PAUL J COOPER CENTER FOR HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-498-5555
Mailing Address - Street 1:519 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5638
Mailing Address - Country:US
Mailing Address - Phone:718-498-5555
Mailing Address - Fax:718-498-6868
Practice Address - Street 1:887 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1309
Practice Address - Country:US
Practice Address - Phone:718-467-6441
Practice Address - Fax:718-467-4921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244931Medicaid
NYWX0421Medicare ID - Type UnspecifiedPROVIDER NUMBER