Provider Demographics
NPI:1720165822
Name:FEGS BRONX MENTAL HEALTH
Entity type:Organization
Organization Name:FEGS BRONX MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-366-8007
Mailing Address - Street 1:3965 SEDGWICK AVE
Mailing Address - Street 2:APT 3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3104
Mailing Address - Country:US
Mailing Address - Phone:718-881-7600
Mailing Address - Fax:718-515-8057
Practice Address - Street 1:3600 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1052
Practice Address - Country:US
Practice Address - Phone:718-881-7600
Practice Address - Fax:718-515-8057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048688251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1H381Medicare ID - Type Unspecified