Provider Demographics
NPI:1366814659
Name:UNITED PRESBYTERIAN & REFORMED ADULT MINISTRIES
Entity type:Organization
Organization Name:UNITED PRESBYTERIAN & REFORMED ADULT MINISTRIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KURTZ
Authorized Official - Suffix:
Authorized Official - Credentials:REV
Authorized Official - Phone:516-364-3401
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-0411
Mailing Address - Country:US
Mailing Address - Phone:516-364-3401
Mailing Address - Fax:516-364-3404
Practice Address - Street 1:322 BROADWAY
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3011
Practice Address - Country:US
Practice Address - Phone:516-364-3401
Practice Address - Fax:516-364-3404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED PRESBYTERIAN & REFORMED ADULT MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01364378Medicaid
NY209205OtherNOT FOR PROFIT