Provider Demographics
NPI:1972126928
Name:ASIAN INDIANS FOR COMMUNITY SERVICE
Entity type:Organization
Organization Name:ASIAN INDIANS FOR COMMUNITY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-318-8056
Mailing Address - Street 1:15800 CRABBS BRANCH WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2685
Mailing Address - Country:US
Mailing Address - Phone:301-318-8056
Mailing Address - Fax:
Practice Address - Street 1:15800 CRABBS BRANCH WAY STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2685
Practice Address - Country:US
Practice Address - Phone:301-318-8056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health