Basic Information
| Provider Information | |||||||||
| NPI: | 1235216722 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE JEWISH BOARD OF FAMILY AND CHILDREN'S SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5601 14TH AVE APT 5E | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112194606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188719262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2795 RICHMOND AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103145857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187619800 | ||||||||
| FaxNumber: | 7183701142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHOOR | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOC. EXECUTIVE DIRECTOR OF ADMIN. | ||||||||
| AuthorizedOfficialTelephone: | 2125829100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 074049-1 | NY | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | W22701 | 01 | NY | MAGELLIN | OTHER | 00074049 | 05 | NY | MEDICAID |