Provider Demographics
NPI:1386678373
Name:DOWNSTATE MENTAL HYGIENE ASSOCIATES
Entity Type:Organization
Organization Name:DOWNSTATE MENTAL HYGIENE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:FEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-287-4806
Mailing Address - Street 1:370 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2206
Mailing Address - Country:US
Mailing Address - Phone:718-287-4806
Mailing Address - Fax:718-287-0337
Practice Address - Street 1:370 LENOX RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2206
Practice Address - Country:US
Practice Address - Phone:718-287-4806
Practice Address - Fax:718-287-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7735100A251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01013583Medicaid
NYW15611Medicare ID - Type Unspecified