NPIMap

Organization Active NPI

Samaritan Village

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bronx, NY
National Provider Identifier
1104298363
Registry record updated Apr 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
SAMARITAN VILLAGE
Practice address
528 Morris Ave
Bronx, NY 10451
Phone
(718) 292-4640
NPI assigned
Oct 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2016

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

Authorized official

Name
Charles Madray
Title
VP of Health Services & Community B
Phone
(718) 206-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

528 Morris Ave
Bronx, NY 10451

Mailing address

138-02 Queens Blvd
Briarwood, NY 11435

Other identifiers 1

IdentifierTypeStateIssuer
00245309MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Samaritan Village21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461888000000",
    "number": "1104298363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138-02 QUEENS BLVD",
            "city": "BRIARWOOD",
            "state": "NY",
            "postal_code": "11435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 MORRIS AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10451",
            "telephone_number": "718-292-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2016-04-29",
        "status": "A",
        "authorized_official_last_name": "MADRAY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "VP OF HEALTH SERVICES & COMMUNITY B",
        "authorized_official_telephone_number": "718-206-2000"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00245309",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2016; 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.