Hazelden New York

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

070411517 Issued in NY

Legal business name

HAZELDEN NEW YORK

Practice address

283 W Broadway
New York, NY 10013-2204

Phone

(800) 257-7800

NPI assigned

Jun 8, 2011

Organization subpart

Yes

Parent organization

HAZELDEN NEW YORKAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ashley Gibson

Title

VP Payer Relations

Phone

(651) 213-4519

Specialties & licenses 2

Addresses

Other names 1

• Tribeca Twelve Other name

Tax ID family

Hazelden New York2 organizations share this tax ID, including this one

Part of

Hazelden New York

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Hazelden New York

  • Substance Use Disorder Rehabilitation Clinic/Center
  • New York, NY
  • NPI 1912064635
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Hazelden New York

  • Substance Use Disorder Rehabilitation Clinic/Center
  • New York, NY
  • NPI 1912064635
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrea Kanter, LCSW

  • Clinical Social Worker
  • New York, NY
  • NPI 1497328009
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747353600000",
    "number": "1053605923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15251 PLEASANT VALLEY RD",
            "city": "CENTER CITY",
            "state": "MN",
            "postal_code": "550129640",
            "telephone_number": "800-257-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 W BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100132204",
            "telephone_number": "800-257-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZELDEN NEW YORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HAZELDEN NEW YORK",
        "enumeration_date": "2011-06-08",
        "last_updated": "2025-05-16",
        "certification_date": "2025-05-16",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "VP PAYER RELATIONS",
        "authorized_official_telephone_number": "651-213-4519"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NY",
            "license": "070411517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tribeca Twelve",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Pushpal Hazari, M.D.
• Leon Hazarian, NP
• Katherine Hazdovac, M.S.
• Karen Hazel, PSY.D.
• Kayla Hazel, PT, DPT, SMFA
• Hazelden New York
• Amanda Hazell, PT, DPT
• Sarah Libbon Hazelton
• Alexes Hazen, M.D.
• Wendy Hazen

• Substance Use Disorder Rehabilitation Clinic/Center in New York, NY
• Providers in New York, NY by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.