Provider Demographics
NPI:1841468840
Name:NYCDOHMH BUREAU OF PUBLIC HEALTH LABS
Entity type:Organization
Organization Name:NYCDOHMH BUREAU OF PUBLIC HEALTH LABS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER THIRD PARTY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SMOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:212-442-8468
Mailing Address - Street 1:125 WORTH STREET BOX 22 RM 901
Mailing Address - Street 2:NYCDOHMH DIVISION OF DISEASE CONTROL THIRD PARTY REVENU
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4006
Mailing Address - Country:US
Mailing Address - Phone:212-442-8468
Mailing Address - Fax:212-442-8452
Practice Address - Street 1:455 FIRST AVENUE RM 147
Practice Address - Street 2:NYCDOHMH BUREAU OF PUBLIC HEALTH LABS PHARMACY DEPARTME
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9102
Practice Address - Country:US
Practice Address - Phone:212-447-2209
Practice Address - Fax:212-447-2889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK CITY DEPARTMENT OF HEALTH & MENTAL HYGIENE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0192333336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
337117OtherNATIONAL COUNCIL FOR PRES