Provider Demographics
NPI:1770529026
Name:BANG AWARENESS ALCOHOL PREVENTION
Entity type:Organization
Organization Name:BANG AWARENESS ALCOHOL PREVENTION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXEC OFFICER
Authorized Official - Prefix:PROF
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNEGHEY
Authorized Official - Suffix:
Authorized Official - Credentials:HHS LPN
Authorized Official - Phone:917-239-5729
Mailing Address - Street 1:1138 E 229TH ST DRIVE SOUTH AVE
Mailing Address - Street 2:6G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:917-239-5729
Mailing Address - Fax:
Practice Address - Street 1:1075 UNIVERSITY AVE
Practice Address - Street 2:STADIUM STATION 524525
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452
Practice Address - Country:US
Practice Address - Phone:347-220-7578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI069164W00000X
NY5292261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Not Answered261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02799640Medicaid