UNDER 21 (NPI# 1053588988) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053588988 |
| Entity Type | Organization |
| Organization Name | UNDER 21 |
| Other Organization Name | COVENANT HOUSE |
| Practice Address |
460 W 41st New York NY 10036 |
| Practice Telephone | 2126130300 |
| Practice Fax Number | 2122682832 |
| Mailing Telephone | 2126130300 |
| Mailing Fax Number | 2122682832 |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2017-06-09 |
| Authorized Official Name | DAVID J DAVIS (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2126130300 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities | ||
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00733826 | 05 |
| Other Name | Type Code |
|---|---|
| Covenant House | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Massachusetts Corporations | UNDER 21 PALACE, INC. | 1526 Stanzione Dr., No. Dighton, MA 02764 |
| Street Address |
460 W 41ST |
| City | NEW YORK |
| State | NY |
| Zip Code | 10036 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689272999 | Caroline Edmunds Purdy | Acupuncturist | 19 West 45th Street Suite 501, New York, NY 10036 | 2020-10-09 |
| 1720612724 | Denisa Dyli | Registered Nurse | 305 West 44th Street, New York, NY 10036 | 2020-02-27 |
| 1023651148 | Trang Bui | Pharmacist | 687 9th Avenue, New York, NY 10036 | 2019-10-21 |
| 1306495361 | Desiree Polonis | Social Worker | 19 W. 45th Street, Suite 705, New York, NY 10036 | 2019-09-11 |
| 1902462575 | Darren Louie | Acupuncturist | 19 W 45th Street, Suite 501, New York, NY 10036 | 2019-05-19 |
| 1477019958 | Esoterra Acupuncture PC | Massage Therapist | 19 W 45 St, Ste 501, New York, NY 10036 | 2019-02-20 |
| 1679045009 | Novel Podiatry Pllc | Podiatrist | 28 West 44th Street, Ste 209, New York, NY 10036 | 2018-12-25 |
| 1699245274 | Anne Michelle Dearwater | Physical Therapist | 36 W44th Street Suite 403, New York, NY 10036 | 2018-11-27 |
| 1154805927 | Christine D'urso | Psychologist | 17-19 W. 45th Street, Suite 907, New York, NY 10036 | 2018-09-18 |
| 1861990335 | Therapath Partners, LLC | Clinical Medical Laboratory | 545 W 45th St Fl 7, New York, NY 10036 | 2018-01-30 |
| Find all providers in zip 10036 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104451525 | Dr Paul Poulakos Do, LLC | Clinic/Center | 186 9th Ave Apt 4f, New York, NY 10011-4918 | 2020-03-05 |
| 1629600101 | Stim Acupuncture and Physical Therapy Pllc | Clinic/Center | 139 Fulton Street, Rm 208, New York, NY 10038-2538 | 2020-02-12 |
| 1811531528 | Beacon Christian Community Health Center, Inc. | Clinic/Center | 115 W 45th St Fl 4, New York, NY 10036-4005 | 2019-11-06 |
| 1629637863 | Fifth Avenue Acup Health Inc | Clinic/Center | 2 W 45th St Ste 1702, New York, NY 10036-4221 | 2019-06-11 |
| 1649837113 | Metro Community Health Centers, Inc | Clinic/Center | 335 East 24th Street, Suite 1b, New York, NY 10010 | 2019-05-21 |
| 1932662624 | Downtown Kids Therapy Ot Pt Slp Pllc | Clinic/Center | 179 Franklin St Unit 4r, New York, NY 10013-2857 | 2019-04-09 |
| 1609347145 | Shannamd | Clinic/Center | 332 E 67th St Apt 14, New York, NY 10065-6265 | 2018-12-10 |
| 1205303591 | Logistics Health Inc. | Clinic/Center | 156 William St Fl 4, New York, NY 10038-2609 | 2018-10-25 |
| 1275018301 | Rks Surgery and Wellness PC | Clinic/Center | 67 Irving Place 10 Th Floor, New York, NY 10003 | 2018-09-25 |
| 1760965453 | Elite Skin Care Nyc | Clinic/Center | 42 Broadway Fl 12, New York, NY 10004-3892 | 2018-09-10 |
| Find all providers in NEW YORK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.