Provider Demographics
NPI:1740599570
Name:NEW YORK STATE PSYCHIATRIC INSTITUTE
Entity Type:Organization
Organization Name:NEW YORK STATE PSYCHIATRIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERIBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED
Authorized Official - Phone:164-662-3779
Mailing Address - Street 1:504 W 136TH ST
Mailing Address - Street 2:APT 6-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7908
Mailing Address - Country:US
Mailing Address - Phone:164-662-3779
Mailing Address - Fax:
Practice Address - Street 1:504 W 136TH ST
Practice Address - Street 2:APT 6-C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7908
Practice Address - Country:US
Practice Address - Phone:164-662-3779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006354-1283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital