Provider Demographics
NPI:1568653806
Name:ALIANZA DOMINICANA, INC.
Entity Type:Organization
Organization Name:ALIANZA DOMINICANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:212-740-1960
Mailing Address - Street 1:2410 AMSTERDAM AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7320
Mailing Address - Country:US
Mailing Address - Phone:212-795-4226
Mailing Address - Fax:212-795-4226
Practice Address - Street 1:715 W 179TH ST
Practice Address - Street 2:BASEMENT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6020
Practice Address - Country:US
Practice Address - Phone:212-795-4226
Practice Address - Fax:212-795-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8655110A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01765140Medicaid