Provider Demographics
NPI:1619354552
Name:SERVICES FOR THE UNDERSERVED, INC.
Entity Type:Organization
Organization Name:SERVICES FOR THE UNDERSERVED, INC.
Other - Org Name:SERVICES FOR THE UNDERSERVED 92ND ST ICF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR - MEDICAID BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:917-408-1642
Mailing Address - Street 1:305 7TH AVE
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6008
Mailing Address - Country:US
Mailing Address - Phone:917-408-1642
Mailing Address - Fax:855-370-9384
Practice Address - Street 1:101-38 92ND STREET
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2205
Practice Address - Country:US
Practice Address - Phone:917-408-1642
Practice Address - Fax:855-370-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7559303320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities