Provider Demographics
NPI:1588907455
Name:PILGRIM PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:PILGRIM PSYCHIATRIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTENSIVE CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALZOKM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-761-4154
Mailing Address - Street 1:175 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3150
Mailing Address - Country:US
Mailing Address - Phone:516-505-2003
Mailing Address - Fax:
Practice Address - Street 1:175 FULTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3150
Practice Address - Country:US
Practice Address - Phone:516-505-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146013200273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146013200Medicaid