Provider Demographics
NPI:1790705085
Name:NYCDOHMH EAST HARLEM DHC
Entity Type:Organization
Organization Name:NYCDOHMH EAST HARLEM DHC
Other - Org Name:NYC DEPT OF HEALTH AND MENTAL HEALTH HYGIENE'S EAST HARLEM DIST
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR MANAGER THIRD PARTY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICAHEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SMOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS IN PUBLIC AD
Authorized Official - Phone:212-232-2423
Mailing Address - Street 1:125 WORTH STREET
Mailing Address - Street 2:BOX 74 RM 901
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4006
Mailing Address - Country:US
Mailing Address - Phone:212-442-8468
Mailing Address - Fax:212-442-8952
Practice Address - Street 1:258 EAST 115TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2031
Practice Address - Country:US
Practice Address - Phone:212-360-5939
Practice Address - Fax:212-876-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002112R1535261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00247645Medicaid