Provider Demographics
NPI:1689201956
Name:LATINO MUSLIMS OF NEW YORK
Entity Type:Organization
Organization Name:LATINO MUSLIMS OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TUSHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-796-1694
Mailing Address - Street 1:655 BURKE AVE APT 5G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6641
Mailing Address - Country:US
Mailing Address - Phone:646-796-1694
Mailing Address - Fax:929-243-3023
Practice Address - Street 1:655 BURKE AVE APT 5G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6641
Practice Address - Country:US
Practice Address - Phone:646-796-1694
Practice Address - Fax:929-243-3023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty