Provider Demographics
NPI:1063950418
Name:THE NEW YORK MILK BANK
Entity type:Organization
Organization Name:THE NEW YORK MILK BANK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHET-HORWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:212-956-5455
Mailing Address - Street 1:185 OLD BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-3801
Mailing Address - Country:US
Mailing Address - Phone:212-956-6455
Mailing Address - Fax:914-471-9703
Practice Address - Street 1:185 OLD BROADWAY
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-3801
Practice Address - Country:US
Practice Address - Phone:212-956-6455
Practice Address - Fax:914-471-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYHM019332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition