NPIMap

Organization Active NPI

Samaritan Daytop Village, Inc.

  • Methadone Clinic
  • Bronx, NY
National Provider Identifier
1235501313
Registry record updated Nov 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
SAMARITAN DAYTOP VILLAGE, INC.
Practice address
362 East 148TH Street
1St & 2ND Floor
Bronx, NY 10455
Phone
(718) 292-4640
NPI assigned
Oct 28, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2023

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 & Comm. Based
Phone
(718) 206-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

362 East 148TH Street
1St & 2ND Floor
Bronx, NY 10455

Mailing address

138-02 Queens Blvd
Briarwood, NY 11435

Other identifiers 1

IdentifierTypeStateIssuer
00245309MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161004000379 NY Part B Supplier - Clinic/Group Practice 8123242906 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bronx, NY

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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

Locations

362 E 148th St
Fl 2
Bronx, NY 10455

Practitioners & affiliated clinicians

Practitioners 4

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

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": "1700006400000",
    "number": "1235501313",
    "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": "362 EAST 148TH STREET",
            "address_2": "1ST & 2ND FLOOR",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10455",
            "telephone_number": "718-292-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN DAYTOP VILLAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A",
        "authorized_official_last_name": "MADRAY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "VP OF HEALTH SERVICES & COMM. BASED",
        "authorized_official_telephone_number": "718-206-2000"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "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 Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.