Provider Demographics
NPI:1801931654
Name:PALLADIA, INC.
Entity type:Organization
Organization Name:PALLADIA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HIV SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:(MSW, LMHC, CASAC)
Authorized Official - Phone:212-979-8800
Mailing Address - Street 1:2006 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1217
Mailing Address - Country:US
Mailing Address - Phone:212-979-8800
Mailing Address - Fax:
Practice Address - Street 1:2006 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1217
Practice Address - Country:US
Practice Address - Phone:212-979-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01854562Medicaid