Provider Demographics
NPI:1073910642
Name:PESACH TIKVAH DOOR OF HOPE
Entity type:Organization
Organization Name:PESACH TIKVAH DOOR OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RIVKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-875-6900
Mailing Address - Street 1:18 MIDDLETON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5415
Mailing Address - Country:US
Mailing Address - Phone:718-875-6900
Mailing Address - Fax:
Practice Address - Street 1:18 MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5415
Practice Address - Country:US
Practice Address - Phone:718-875-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0885731251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health