Provider Demographics
NPI:1871793356
Name:COMMUNITY HEALTH ACTION OF STATEN ISLAND, INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH ACTION OF STATEN ISLAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SNR. VP/CHIEF FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LYTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-808-1422
Mailing Address - Street 1:56 BAY ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2563
Mailing Address - Country:US
Mailing Address - Phone:718-808-1300
Mailing Address - Fax:718-808-1393
Practice Address - Street 1:56 BAY ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2563
Practice Address - Country:US
Practice Address - Phone:718-808-1300
Practice Address - Fax:718-808-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080311454251S00000X
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02521240Medicaid