NPIMap

Organization Active NPI

Eating Disorder Treatment of New York, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • West Nyack, NY
National Provider Identifier
1114726411
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
EATING DISORDER TREATMENT OF NEW YORK, LLC
Practice address
259 Sickletown Rd
West Nyack, NY 10994-2905
Phone
(845) 379-9330
NPI assigned
Mar 10, 2025
Last updated
Jun 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

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

Authorized official

Name
Jason Schultz
Title
Cfo
Phone
(720) 440-4277

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

259 Sickletown Rd
West Nyack, NY 10994-2905

Mailing address

6100 SW 76TH St
South Miami, FL 33143-5002
Phone (845) 379-9330

National Provider Directory

National Provider Directory
Tax ID family
Eating Disorder Treatment of New York LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1741564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1114726411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 SW 76TH ST",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331435002",
            "telephone_number": "845-379-9330",
            "fax_number": "845-818-3865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 SICKLETOWN RD",
            "city": "WEST NYACK",
            "state": "NY",
            "postal_code": "109942905",
            "telephone_number": "845-379-9330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EATING DISORDER TREATMENT OF NEW YORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-10",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "720-440-4277"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Nyack, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.