Provider Demographics
NPI:1194916858
Name:PUBLIC HEALTH SOLUTIONS
Entity type:Organization
Organization Name:PUBLIC HEALTH SOLUTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-619-6401
Mailing Address - Street 1:220 CHURCH ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2904
Mailing Address - Country:US
Mailing Address - Phone:646-619-6400
Mailing Address - Fax:646-619-6782
Practice Address - Street 1:4215 3RD AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4501
Practice Address - Country:US
Practice Address - Phone:718-294-5891
Practice Address - Fax:718-294-2468
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUBLIC HEALTH SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-07
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002296R261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00245538Medicaid