Provider Demographics
NPI:1013242726
Name:NYCDOHMH-BOARD OF ED
Entity Type:Organization
Organization Name:NYCDOHMH-BOARD OF ED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, MEDICAID & MEDICARE REVEN
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:ELLIOT
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-232-2423
Mailing Address - Street 1:42 BROADWAY
Mailing Address - Street 2:SUITE 1611
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1617
Mailing Address - Country:US
Mailing Address - Phone:212-232-2421
Mailing Address - Fax:
Practice Address - Street 1:2 LAFAYETTE ST
Practice Address - Street 2:22ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1307
Practice Address - Country:US
Practice Address - Phone:212-676-2474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01647043261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01647043Medicaid
NY09N131Medicare UPIN