Mission of the Immaculate

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

7943430 Issued in NY

Legal business name

MISSION OF THE IMMACULATE

Practice address

6581 Hylan Blvd
Staten Island, NY 10309-3830

Phone

(718) 317-2803

Fax

(718) 317-2830

NPI assigned

Oct 18, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Stephen W Rynn

Title

Executive Director

Phone

(718) 317-2803

Specialties & licenses 1

Addresses

Other identifiers 4

Tax ID family

Mission of the Immaculate2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Mission of the Immaculate Virgin

  • Case Management Agency
  • Staten Island, NY
  • NPI 1982886958
  NPD tax ID

Locations

Practitioners 1

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

• Wai-Kwok Tam, MD

  • Internal Medicine Physician
  • Staten Island, NY
  • NPI 1023093614
  NPD (past)

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192665600000",
    "number": "1750570495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6581 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103093830",
            "telephone_number": "718-317-2803",
            "fax_number": "718-317-2830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6581 HYLAN BLVD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103093830",
            "telephone_number": "718-317-2803",
            "fax_number": "718-317-2830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION OF THE IMMACULATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2007-10-18",
        "status": "A",
        "authorized_official_last_name": "RYNN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "718-317-2803",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NY",
            "license": "7943430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02253478",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02700118",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02002633",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01102721",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Marie Misiti
• Susan Miskin, SP ED/ MS
• Esther Misrahi Elting, MSOTR/L
• Christopher Missak, D.O.
• Brittany Anne Misseri
• Mission of the Immaculate Virgin
• Mission of the Immaculate Virgin
• Charles J Mistretta, D.D.S.
• Jaclyn Mistretta, LCSW
• Mitchell a. Schuman, MD,PC

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; 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.