Provider Demographics
NPI: | 1639687999 |
---|---|
Name: | NYCHH ELMHURTS HOSPITAL CENTER |
Entity Type: | Organization |
Organization Name: | NYCHH ELMHURTS HOSPITAL CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ISRAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ROCHA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 718-334-1638 |
Mailing Address - Street 1: | 173 HENRY ST APT 7C |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10002-6477 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 917-360-0370 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7901 BROADWAY RM BA-1A |
Practice Address - Street 2: | |
Practice Address - City: | ELMHURST |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11373-1329 |
Practice Address - Country: | US |
Practice Address - Phone: | 718-334-2518 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-01-19 |
Last Update Date: | 2018-01-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 86071263 | 133V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Single Specialty |