NPIMap

Organization Active NPI

Nycdohmh Bed Stuy Connect CMCM

  • Community Health Clinic/Center
  • Brooklyn, NY
National Provider Identifier
1316993306
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
01234404026 Issued in NY
Legal business name
NYCDOHMH BED STUY CONNECT CMCM
Practice address
20 New York Avenue
Nycdohmh Bed Stuy Connect CMCM
Brooklyn, NY 11216-2629
Phone
(718) 398-5005
Fax
(718) 398-5033
NPI assigned
May 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Michael James Smook, MPA
Title
Administrative MGR 3D Party Revenue
Phone
(212) 442-8468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 01234404026 NY Primary

Addresses

Primary practice location

20 New York Avenue
Nycdohmh Bed Stuy Connect CMCM
Brooklyn, NY 11216-2629

Mailing address

125 Worth Street
Nycdohmh Div of Disease Control RM 901 Box 22
New York, NY 10013-4006
Phone (212) 442-8468

Other identifiers 1

IdentifierTypeStateIssuer
01234404MedicaidNY

Other names 1

  • NYC Dept of Health & Mental Hygiene Bed Stuy Connect CMCM Other name

National Provider Directory

National Provider Directory
Tax ID family
Rochelle Cherry46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

Locations

20 New York Ave
Brooklyn, NY 11216
Phone (718) 398-5005

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316993306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 WORTH STREET",
            "address_2": "NYCDOHMH DIV OF DISEASE CONTROL RM 901 BOX 22",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100134006",
            "telephone_number": "212-442-8468",
            "fax_number": "212-442-8452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 NEW YORK AVENUE",
            "address_2": "NYCDOHMH BED STUY CONNECT CMCM",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112162629",
            "telephone_number": "718-398-5005",
            "fax_number": "718-398-5033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NYCDOHMH BED STUY CONNECT CMCM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMOOK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "ADMINISTRATIVE MGR 3D PARTY REVENUE",
        "authorized_official_telephone_number": "212-442-8468",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NY",
            "license": "01234404026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01234404",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NYC Dept of Health & Mental Hygiene Bed Stuy Connect CMCM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Aug 22, 2020; 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.