Provider Demographics
NPI:1851571392
Name:BROWNSVILLE COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:BROWNSVILLE COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:BMS-ISIS @ BRISTOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-345-5000
Mailing Address - Street 1:259 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:259 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5540
Practice Address - Country:US
Practice Address - Phone:718-345-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROWNSVILLE COMMUNIT DEVELOPMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-13
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00723253Medicaid
NY331958Medicare PIN