Provider Demographics
NPI:1568751964
Name:MORRISANIA D&TC
Entity Type:Organization
Organization Name:MORRISANIA D&TC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOTO
Authorized Official - Suffix:
Authorized Official - Credentials:CW
Authorized Official - Phone:718-960-2915
Mailing Address - Street 1:1225 GERARD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1225 GERARD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8001
Practice Address - Country:US
Practice Address - Phone:718-960-2915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service