Provider Demographics
NPI:1932694312
Name:ART 58 INC
Entity Type:Organization
Organization Name:ART 58 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKUYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-668-9100
Mailing Address - Street 1:50 LAURIE CT
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3556
Mailing Address - Country:US
Mailing Address - Phone:732-668-9100
Mailing Address - Fax:
Practice Address - Street 1:2797 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7870
Practice Address - Country:US
Practice Address - Phone:732-668-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070654-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty