Provider Demographics
NPI:1376916635
Name:EDITH
Entity Type:Organization
Organization Name:EDITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-288-0036
Mailing Address - Street 1:2123 41ST ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1708
Mailing Address - Country:US
Mailing Address - Phone:718-755-5328
Mailing Address - Fax:
Practice Address - Street 1:2123 41ST ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1708
Practice Address - Country:US
Practice Address - Phone:718-755-5328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY692510273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit