Provider Demographics
NPI:1770553752
Name:USCG SECTOR NEW YORK
Entity type:Organization
Organization Name:USCG SECTOR NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARMENTROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-354-4341
Mailing Address - Street 1:215 DRUM ROAD
Mailing Address - Street 2:ROOM D-113
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-354-4414
Mailing Address - Fax:718-354-4415
Practice Address - Street 1:215 DRUM ROAD
Practice Address - Street 2:ROOM D-113
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-354-4414
Practice Address - Fax:718-354-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050128261QM1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY9005916Medicare UPIN