Provider Demographics
NPI:1093800211
Name:INSTITUTE FOR THE PUERTO RICAN HISPANIC ELDERLY INC.
Entity type:Organization
Organization Name:INSTITUTE FOR THE PUERTO RICAN HISPANIC ELDERLY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SULELKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA-DRINANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-677-4181
Mailing Address - Street 1:37-20 76TH STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6502
Mailing Address - Country:US
Mailing Address - Phone:718-478-1526
Mailing Address - Fax:718-429-0738
Practice Address - Street 1:37-20 76TH STREET
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6502
Practice Address - Country:US
Practice Address - Phone:718-478-1526
Practice Address - Fax:718-429-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9138110A & B1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY424111739OtherHEALTHPLUS
NY01975626Medicaid
NY01975626Medicaid