Provider Demographics
NPI:1295912541
Name:MOUNT VERNON NEIGHBORHOOD HEALTH CENTER INC
Entity type:Organization
Organization Name:MOUNT VERNON NEIGHBORHOOD HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR PATIENT ACCOUNTS
Authorized Official - Prefix:MS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-989-7600
Mailing Address - Street 1:107 W 4TH ST
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4002
Mailing Address - Country:US
Mailing Address - Phone:914-699-7200
Mailing Address - Fax:914-699-0837
Practice Address - Street 1:107 W 4TH ST
Practice Address - Street 2:ADMINISTRATION
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4002
Practice Address - Country:US
Practice Address - Phone:914-699-7200
Practice Address - Fax:914-699-0837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT VERNON NEIGHORHOOD HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-29
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5903200R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995522Medicaid
NYW12121Medicare PIN