Provider Demographics
NPI:1922475235
Name:ODYSSEY HEALTH SERVICES
Entity Type:Organization
Organization Name:ODYSSEY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-361-1678
Mailing Address - Street 1:120 WALL ST
Mailing Address - Street 2:17TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-3904
Mailing Address - Country:US
Mailing Address - Phone:212-361-1678
Mailing Address - Fax:212-361-1666
Practice Address - Street 1:219 E 121 ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-361-1678
Practice Address - Fax:212-361-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)