NPIMap

Organization Active NPI

Bridge Back to Life Center, Inc.

  • Clinical Social Worker
  • Brooklyn, NY
National Provider Identifier
1184041998
Registry record updated Nov 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
141111254 Issued in NY
Legal business name
BRIDGE BACK TO LIFE CENTER, INC.
Practice address
3044 Coney Island Ave
3Rd Floor
Brooklyn, NY 11235-5660
Phone
(718) 265-4200
Fax
(718) 265-8536
NPI assigned
Mar 19, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2018

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

Authorized official

Name
Mr. Gary Butchen, LCSW-R, SAP
Title
President
Phone
(516) 520-6600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 141111254 NY Primary
Addiction (Substance Use Disorder) Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WA0400X 141111254 NY

Addresses

Primary practice location

3044 Coney Island Ave
3Rd Floor
Brooklyn, NY 11235-5660

Mailing address

4271 Hempstead Tpke
Bethpage, NY 11714-5708
Phone (516) 520-6600

Other identifiers 1

IdentifierTypeStateIssuer
01439087MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Bridge Back to Life Center Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

3044 Coney Island Ave
Ste 3
Brooklyn, NY 11235
Phone (718) 265-4200

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541548800000",
    "number": "1184041998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4271 HEMPSTEAD TPKE",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145708",
            "telephone_number": "516-520-6600",
            "fax_number": "516-520-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3044 CONEY ISLAND AVE",
            "address_2": "3RD FLOOR",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355660",
            "telephone_number": "718-265-4200",
            "fax_number": "718-265-8536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE BACK TO LIFE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-19",
        "last_updated": "2018-11-07",
        "status": "A",
        "authorized_official_last_name": "BUTCHEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-520-6600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW-R, SAP"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "141111254",
            "primary": true
        },
        {
            "code": "163WA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "141111254",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01439087",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; 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.