Provider Demographics
NPI:1619034154
Name:NYS OFFICE OF MENTAL HEALTH
Entity Type:Organization
Organization Name:NYS OFFICE OF MENTAL HEALTH
Other - Org Name:BRONX PSYCHIATRIC CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-473-0795
Mailing Address - Street 1:44 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12229-0001
Mailing Address - Country:US
Mailing Address - Phone:518-473-8234
Mailing Address - Fax:518-473-5167
Practice Address - Street 1:1500 WATERS PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2723
Practice Address - Country:US
Practice Address - Phone:718-931-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00476797Medicaid
NY00476797Medicaid