Provider Demographics
NPI:1831507573
Name:NATHANIEL CHAMBERS
Entity type:Organization
Organization Name:NATHANIEL CHAMBERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CASAC
Authorized Official - Phone:212-864-4128
Mailing Address - Street 1:801 SAINT ANNS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-7648
Mailing Address - Country:US
Mailing Address - Phone:347-595-7246
Mailing Address - Fax:
Practice Address - Street 1:801 SAINT ANNS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-7648
Practice Address - Country:US
Practice Address - Phone:347-595-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder