Provider Demographics
NPI:1689656027
Name:NEW YORK ASSOCIATION FOR NEW AMERICANS, INC
Entity Type:Organization
Organization Name:NEW YORK ASSOCIATION FOR NEW AMERICANS, INC
Other - Org Name:FIFTH AVENUE CENTER FOR COUNSELING AND PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-989-2990
Mailing Address - Street 1:50 WEST 23RD STREET
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:212-989-2990
Mailing Address - Fax:212-792-6058
Practice Address - Street 1:50 WEST 23RD STREET
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-989-2990
Practice Address - Fax:212-792-6058
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK ASSOCIATION FOR NEW AMERICANS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-18
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7122110A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02411181Medicaid
A100000394Medicare PIN