Provider Demographics
NPI:1619216033
Name:LINCOLN MEDICAL AND MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:LINCOLN MEDICAL AND MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR,TRANSITIONAL YEAR
Authorized Official - Prefix:DR
Authorized Official - First Name:BALAVENKATESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-579-6476
Mailing Address - Street 1:234 E 149TH ST
Mailing Address - Street 2:5C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5504
Mailing Address - Country:US
Mailing Address - Phone:718-579-6476
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:5C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-6476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital