Provider Demographics
NPI:1417318007
Name:NEW YORK STATE OFFICE OF MENTAL HEALTH
Entity Type:Organization
Organization Name:NEW YORK STATE OFFICE OF MENTAL HEALTH
Other - Org Name:SOUTH BEACH PSYCHIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REHABILITATION COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HINGWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:718-974-2615
Mailing Address - Street 1:777 SEAVIEW AVE.
Mailing Address - Street 2:SBPC - HEALTH HOME PROGRAM
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-974-2615
Mailing Address - Fax:718-668-8070
Practice Address - Street 1:777 SEAVIEW AVE
Practice Address - Street 2:SBPC HEALTH HOME PROGRAM
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3409
Practice Address - Country:US
Practice Address - Phone:718-668-8061
Practice Address - Fax:718-668-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital