Organization Active NPI

Mission of the Immaculate Virgin

  • Case Management Agency
  • Staten Island, NY
National Provider Identifier
1841479193
Registry record updated Jul 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
License
7943436 Issued in NY
Legal business name
MISSION OF THE IMMACULATE VIRGIN
Practice address
6581 Hylan Blvd
Staten Island, NY 10309-3830
Phone
(718) 317-2803
Fax
(718) 317-2830
NPI assigned
Nov 2, 2007
Last updated
Jul 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2008

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

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 7943436 NY Primary

Addresses

Primary practice location

6581 Hylan Blvd
Staten Island, NY 10309-3830

Mailing address

6581 Hylan Blvd
Staten Island, NY 10309-3830
Phone (718) 317-2803

Other identifiers 1

IdentifierTypeStateIssuer
02002633MedicaidNY

National Provider Directory

National Provider Directory

Locations

6581 Hylan Blvd
Staten Island, NY 10309
Phone (718) 317-2842

NPI Registry JSON

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

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217462400000",
    "number": "1841479193",
    "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 VIRGIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-02",
        "last_updated": "2008-07-31",
        "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": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NY",
            "license": "7943436",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02002633",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2008; 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.