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8268 164th St Jamaica NY 11432-1121 | |
| (718) 883-2626 | |
| (718) 883-6200 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 8268 164th St, Jamaica, New York |
| Authorized Official Name and Position | Maxine J Katz (ASSISTANT VICE PRESIDENT) |
| Authorized Official Contact | 6464583402 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
160 Water St Room 736 New York NY 10038-4922 Ph: (646) 458-3402 | 8268 164th St Jamaica NY 11432-1121 Ph: (718) 883-2626 |
| NPI Number | 1710105200 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 08/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710105200 | NPI | - | NPPES |
| 02722145 | Medicaid | NY | |
| 02997024 | Medicaid | NY | |
| 02556870 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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