Provider Demographics
NPI:1689156259
Name:KINGSBORO PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:KINGSBORO PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADON
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-221-7145
Mailing Address - Street 1:10 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-3950
Mailing Address - Country:US
Mailing Address - Phone:718-388-3075
Mailing Address - Fax:
Practice Address - Street 1:10 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-3950
Practice Address - Country:US
Practice Address - Phone:718-338-3075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY507498-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care