Provider Demographics
NPI:1104176395
Name:DEPARTEMENT OF HEALTH AND MENTAL HYGIENE
Entity type:Organization
Organization Name:DEPARTEMENT OF HEALTH AND MENTAL HYGIENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT CARE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-476-7123
Mailing Address - Street 1:3433 JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3828
Mailing Address - Country:US
Mailing Address - Phone:718-476-7636
Mailing Address - Fax:718-476-7131
Practice Address - Street 1:3433 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3828
Practice Address - Country:US
Practice Address - Phone:718-476-7636
Practice Address - Fax:718-476-7131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY545218-1261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health