Provider Demographics
NPI:1013324441
Name:NEW YORK BRIDGE CENTER, LLC
Entity Type:Organization
Organization Name:NEW YORK BRIDGE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-826-1840
Mailing Address - Street 1:944 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3003
Mailing Address - Country:US
Mailing Address - Phone:516-826-1840
Mailing Address - Fax:516-826-1839
Practice Address - Street 1:944 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3003
Practice Address - Country:US
Practice Address - Phone:516-826-1840
Practice Address - Fax:516-826-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care