Provider Demographics
NPI:1447380316
Name:FORDHAM-TREMONT
Entity Type:Organization
Organization Name:FORDHAM-TREMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMARILIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LABOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-960-9000
Mailing Address - Street 1:1669 UNIVERSITY AVE.
Mailing Address - Street 2:APT 4E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:718-901-7901
Mailing Address - Fax:
Practice Address - Street 1:2021 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4304
Practice Address - Country:US
Practice Address - Phone:718-960-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management