Provider Demographics
NPI:1497426944
Name:BROOKRISE THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:BROOKRISE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KURIA-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:929-410-7023
Mailing Address - Street 1:218 STUYVESANT AVE
Mailing Address - Street 2:OFFICE #4 SECOND FLOOR
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1726
Mailing Address - Country:US
Mailing Address - Phone:929-410-7023
Mailing Address - Fax:609-228-7928
Practice Address - Street 1:5191 ROUTE 32
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-6522
Practice Address - Country:US
Practice Address - Phone:929-410-7023
Practice Address - Fax:800-584-1480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)