Provider Demographics
NPI:1831269315
Name:THE BRIDGE, INC.
Entity type:Organization
Organization Name:THE BRIDGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIVIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:212-663-3000
Mailing Address - Street 1:248 W 108TH ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2956
Mailing Address - Country:US
Mailing Address - Phone:212-663-3000
Mailing Address - Fax:212-280-1793
Practice Address - Street 1:248 W 108TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2956
Practice Address - Country:US
Practice Address - Phone:212-663-3000
Practice Address - Fax:212-280-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00273267Medicaid
NY01305059Medicaid
NY02187240Medicaid
NYW32631Medicare ID - Type UnspecifiedMEDICARE ID