Provider Demographics
NPI:1518338409
Name:QSPOT LGBT COMMUNITY CENTER
Entity type:Organization
Organization Name:QSPOT LGBT COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKYTUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-675-2726
Mailing Address - Street 1:66 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07756-1295
Mailing Address - Country:US
Mailing Address - Phone:732-455-3373
Mailing Address - Fax:
Practice Address - Street 1:66 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OCEAN GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07756-1295
Practice Address - Country:US
Practice Address - Phone:732-455-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-17
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare