Provider Demographics
NPI:1932374972
Name:TRANSITIONAL SERVICES FOR NY
Entity Type:Organization
Organization Name:TRANSITIONAL SERVICES FOR NY
Other - Org Name:TSI
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-746-6647
Mailing Address - Street 1:1016 162ND ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2124
Mailing Address - Country:US
Mailing Address - Phone:718-746-6647
Mailing Address - Fax:718-746-6799
Practice Address - Street 1:1016 162ND ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2124
Practice Address - Country:US
Practice Address - Phone:718-746-6647
Practice Address - Fax:718-746-6799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02736932Medicaid