Provider Demographics
NPI:1679620090
Name:THE DOOR - A CENTER OF ALTERNATIVES, INC.
Entity Type:Organization
Organization Name:THE DOOR - A CENTER OF ALTERNATIVES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADOLESCENT HEALTH SERVI
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:212-453-0209
Mailing Address - Street 1:121 AVENUE OF THE AMERICAS
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-1510
Mailing Address - Country:US
Mailing Address - Phone:212-941-9090
Mailing Address - Fax:212-941-9614
Practice Address - Street 1:121 AVENUE OF THE AMERICAS
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1510
Practice Address - Country:US
Practice Address - Phone:212-941-9090
Practice Address - Fax:212-941-9614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118888-12080A0000X
NY261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03824935Medicaid