Provider Demographics
NPI:1669706628
Name:MBHW, INC.
Entity type:Organization
Organization Name:MBHW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SAZER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:845-382-1200
Mailing Address - Street 1:24 LOHMAIER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-5245
Mailing Address - Country:US
Mailing Address - Phone:845-382-1200
Mailing Address - Fax:845-336-7510
Practice Address - Street 1:218 STONE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3211
Practice Address - Country:US
Practice Address - Phone:315-782-7400
Practice Address - Fax:315-782-7432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7928002A261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)