Provider Demographics
NPI:1821826652
Name:STATEN ISLAND PERFORMING PROVIDER SYSTEM
Entity type:Organization
Organization Name:STATEN ISLAND PERFORMING PROVIDER SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:917-830-1141
Mailing Address - Street 1:1 EDGEWATER ST STE 700
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4902
Mailing Address - Country:US
Mailing Address - Phone:917-830-1141
Mailing Address - Fax:
Practice Address - Street 1:1 EDGEWATER ST STE 700
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4902
Practice Address - Country:US
Practice Address - Phone:917-830-1141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management