Provider Demographics
NPI:1760441489
Name:BOYS CLUB OF NEW YORK
Entity Type:Organization
Organization Name:BOYS CLUB OF NEW YORK
Other - Org Name:THE BOYS CLUB OF NEW YORK
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZERVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-533-2554
Mailing Address - Street 1:287 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4816
Mailing Address - Country:US
Mailing Address - Phone:212-533-2554
Mailing Address - Fax:212-353-0016
Practice Address - Street 1:287 E 10TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-4816
Practice Address - Country:US
Practice Address - Phone:212-533-2554
Practice Address - Fax:212-353-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261Q00000X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental