Provider Demographics
NPI:1689854820
Name:LOWER EASTSIDE SERVICE CENTER
Entity Type:Organization
Organization Name:LOWER EASTSIDE SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:TROICKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:212-343-3565
Mailing Address - Street 1:203 STULTS LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5821
Mailing Address - Country:US
Mailing Address - Phone:201-978-4985
Mailing Address - Fax:
Practice Address - Street 1:46 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6803
Practice Address - Country:US
Practice Address - Phone:212-343-3565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health