NYCDOHMH MOTTHYN CONNECT CMCM NPI 1104872506

NPI Information

NPI: 1104872506
Provider Name: NYCDOHMH MOTTHYN CONNECT CMCM

Other Name: NYC DEPT OF HEALTH & MENTAL HYGIENE MOTT HAVEN CONNECT CMCM

Classification: Clinic/Center - 261QC1500X
Entity Type: Organization

Specialization: Community Health

Address:
1309 FULTON AVENUE
NYCDOHMH MOTT HAVEN CONNECT CMCM
BRONX, NY
ZIP 10456
Phone: (718) 367-2450
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NYCDOHMH MOTTHYN CONNECT CMCM is a community health clinic center in Bronx, NY. NYCDOHMH MOTTHYN CONNECT CMCM NPI is 1104872506. The provider is registered as an organization entity type.
The provider Other Name Is Nyc Dept Of Health & Mental Hygiene Mott Haven Connect Cmcm.

The provider's business location address is:

1309 FULTON AVENUE
NYCDOHMH MOTT HAVEN CONNECT CMCM
BRONX, NY
ZIP 10456-403
Phone: (718) 367-2450
Fax: (718) 367-5112

The provider's authorized official is Michael James Smook .
The authorized official title is Administrative Mgr 3d Party Revenue and has the following contact phone number (212) 442-5468.

The enumeration date for this NPI number is 5/26/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QC1500X	Clinic/Center	Community Health	01234413026	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	01234413	MEDICAID	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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