Provider Demographics
NPI:1396215513
Name:PGCMH
Entity Type:Organization
Organization Name:PGCMH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RONIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEMI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:212-560-6700
Mailing Address - Street 1:1775 GRAND CONCOURSE 8TH FL
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:212-560-6700
Mailing Address - Fax:
Practice Address - Street 1:1775 GRAND CONCOURSE 8TH FL
Practice Address - Street 2:
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:212-560-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244257Medicaid