Provider Demographics
NPI:1316377534
Name:PALLADIA WELLNESS CLINIC
Entity Type:Organization
Organization Name:PALLADIA WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HURWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-979-8800
Mailing Address - Street 1:2006 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1217
Mailing Address - Country:US
Mailing Address - Phone:212-979-8800
Mailing Address - Fax:212-979-0100
Practice Address - Street 1:2250 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2208
Practice Address - Country:US
Practice Address - Phone:212-400-3230
Practice Address - Fax:212-400-3231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALLADIA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8898001A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health