Provider Demographics
NPI:1679517775
Name:NYCDOHMH BUR MATERN CONNECT FAC
Entity Type:Organization
Organization Name:NYCDOHMH BUR MATERN CONNECT FAC
Other - Org Name:NEW YORK CITY DEPARMENT OF HEALTH AND MENTAL HYGIENES BUREAU OF MATERN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER THIRD PARTY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SMOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:212-442-8468
Mailing Address - Street 1:125 WORTH STREET
Mailing Address - Street 2:BOX 74 RM 901 NYCDOHMH DIVISION OF DISEASE CONTROL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4006
Mailing Address - Country:US
Mailing Address - Phone:212-442-8468
Mailing Address - Fax:212-442-8452
Practice Address - Street 1:2 LAFAYETTE STREET
Practice Address - Street 2:BOX 34A 18TH FLOOR NYCDOHMH BUR MATERN CONNECT FAC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1322
Practice Address - Country:US
Practice Address - Phone:212-442-1740
Practice Address - Fax:212-442-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01214617026261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0144617Medicaid