Provider Demographics
NPI:1558419762
Name:NORTH CROWN HEIGHTS FAMILY OUTREACH CENTER INC
Entity Type:Organization
Organization Name:NORTH CROWN HEIGHTS FAMILY OUTREACH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-398-8700
Mailing Address - Street 1:666 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3706
Mailing Address - Country:US
Mailing Address - Phone:718-398-8700
Mailing Address - Fax:718-398-5770
Practice Address - Street 1:666 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3706
Practice Address - Country:US
Practice Address - Phone:718-398-8700
Practice Address - Fax:718-398-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050411459101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02252972Medicaid