Provider Demographics
NPI:1871274928
Name:MINDS WITH PURPOSE
Entity type:Organization
Organization Name:MINDS WITH PURPOSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VIKTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:646-464-4884
Mailing Address - Street 1:4 ROMER RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1227
Mailing Address - Country:US
Mailing Address - Phone:646-464-4884
Mailing Address - Fax:
Practice Address - Street 1:1110 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3403
Practice Address - Country:US
Practice Address - Phone:718-698-6905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management