Provider Demographics
NPI:1326519612
Name:HASC DIAGNOSTIC & TREATMENT CENTER, INC
Entity Type:Organization
Organization Name:HASC DIAGNOSTIC & TREATMENT CENTER, INC
Other - Org Name:RAMBAM FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:NECHEMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-535-1961
Mailing Address - Street 1:5601 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2517
Mailing Address - Country:US
Mailing Address - Phone:718-745-7575
Mailing Address - Fax:
Practice Address - Street 1:1122 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5844
Practice Address - Country:US
Practice Address - Phone:718-942-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HASC DIAGNOSTIC & TREATMENT CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-11
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2186092Medicaid