BRIDGE BACK TO LIFE (NPI# 1700114139) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700114139 |
| Entity Type | Organization |
| Organization Name | BRIDGE BACK TO LIFE |
| Practice Address |
500 8th Ave Rm 906 New York NY 10018-4190 |
| Practice Telephone | 2126794960 |
| Mailing Telephone | 2126794960 |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2009-11-23 |
| Authorized Official Name | MR. WILLIAM BRELAND (COUNSELOR) |
| Authorized Official Telephone | 2126794960 |
| Authorized Official Credential | CASAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
19634 | NY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | CASAC | 19634 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962862987 | Bridge Back To Life | Substance Abuse Rehabilitation Facility | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2016-03-03 |
| 1083942411 | Bridge Back To Life | Clinic/Center | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2009-11-23 |
| Street Address |
500 8TH AVE RM 906 |
| City | NEW YORK |
| State | NY |
| Zip Code | 10018-4190 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215185707 | Hilda Dozier | Counselor | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2008-09-09 |
| 1962862987 | Bridge Back To Life | Substance Abuse Rehabilitation Facility | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2016-03-03 |
| 1144637398 | Qiana Ware | Counselor | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2014-07-21 |
| 1366877961 | Koichi Togawa | Counselor | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2013-09-13 |
| 1942646096 | Paul Fishkin | Counselor | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2013-05-16 |
| 1245676436 | Gary Alleyne | Counselor | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2013-05-15 |
| 1407292790 | Anthony Scolavino | Counselor | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2013-05-14 |
| 1487997904 | Christina M Penna | Counselor | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2013-04-03 |
| 1780927202 | Johanna M Caruso | Counselor | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2013-04-03 |
| 1790023927 | Gabrielle Jakob | Counselor | 500 8th Ave Rm 906, New York, NY 10018-4190 | 2013-01-23 |
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|---|---|---|---|---|
| 1205451325 | Nishi Sanjay Patel | Physical Therapist | 12 West 37th Street, Suite 1202, New York, NY 10018 | 2020-06-15 |
| 1962023168 | Brand Therapy Psychological Services PC | Psychologist | 50 West 39th St, Suite 305, New York, NY 10018 | 2020-04-29 |
| 1215587985 | Nicole Kosanke | Psychologist | 519 8th Avenue, 9th Floor, New York, NY 10018 | 2019-09-16 |
| 1487216073 | Roselaure Luca | Nurse Practitioner | 5 Bryant Park, 5th Floor, New York, NY 10018 | 2019-07-03 |
| 1609439942 | Kamiyama Physical Therapy Pllc | Physical Therapist | 1410 Broadway Concourse Level, New York, NY 10018 | 2019-04-22 |
| 1609339126 | Bryan I. Proano | Social Worker | 550 10th Ave., New York, NY 10018 | 2019-04-11 |
| 1053876318 | Nitzia Mariana Dacosta | Registered Nurse | 505 8th Ave Suite 200, New York, NY 10018 | 2019-01-31 |
| 1871060640 | Jose Jean Paul Miliano | Case Manager/Care Coordinator | 535 Eighth Avenue. 2nd Floor, New York, NY 10018 | 2018-10-30 |
| 1902372220 | Stephanie Lai | Social Worker | 550 Tenth Avenue, New York, NY 10018 | 2018-10-15 |
| 1528554912 | Positive Health Project, Inc. | Counselor | 301 W 37th St Fl 3, New York, NY 10018 | 2018-07-09 |
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| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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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.