Provider Demographics
NPI:1952766396
Name:PIBLY RESIDENTIAL PROGRAMS, INC.
Entity type:Organization
Organization Name:PIBLY RESIDENTIAL PROGRAMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:718-863-4100
Mailing Address - Street 1:2415 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3538
Mailing Address - Country:US
Mailing Address - Phone:718-863-4100
Mailing Address - Fax:718-863-5165
Practice Address - Street 1:2415 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3538
Practice Address - Country:US
Practice Address - Phone:718-863-4100
Practice Address - Fax:718-863-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035393251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management