Provider Demographics
NPI:1477684967
Name:BOWERY RESIDENTS' COMMITTEE, INC.
Entity Type:Organization
Organization Name:BOWERY RESIDENTS' COMMITTEE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-803-5701
Mailing Address - Street 1:131 W 25TH ST
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7207
Mailing Address - Country:US
Mailing Address - Phone:212-803-5700
Mailing Address - Fax:212-533-1893
Practice Address - Street 1:131 W 25TH ST
Practice Address - Street 2:12TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7207
Practice Address - Country:US
Practice Address - Phone:212-803-5700
Practice Address - Fax:212-533-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NY150311840251S00000X
NY151110622251S00000X
NY131110622261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01571879Medicaid
NY00839249Medicaid
NY01312918Medicaid