Provider Demographics
NPI:1609486554
Name:ACCESS SADC UPTOWN LLC.
Entity Type:Organization
Organization Name:ACCESS SADC UPTOWN LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLEGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-645-3265
Mailing Address - Street 1:64 E 111TH ST APT 907
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2688
Mailing Address - Country:US
Mailing Address - Phone:347-645-3265
Mailing Address - Fax:
Practice Address - Street 1:64 E 111TH ST APT 907
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2688
Practice Address - Country:US
Practice Address - Phone:347-645-3265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care