Ibr George A Jervis Clinic

LBN: State Of New York Comptrollers Office
Ibr George A Jervis Clinic is an health care organization with primary practice located at 1050 Forest Hill Rd , Staten Island NY 10314-6356. The organization recently has only one registered license in Ambulatory Health Care Facilities / Developmental Disabilities, which is considered as the primary health care specialty. State Of New York Comptrollers Office can be contacted via phone (718) 494-5151, or through Jefferson, Earl via phone (518) 402-4333.

Contact Information

Primary practice address
1050 Forest Hill Rd Staten Island NY 10314-6356
Phone: (718) 494-5151
Fax: (718) 494-2258
Website:
Map and Directions
Authorized official contact:
Name: Jefferson, Earl
Phone: (518) 402-4333

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Developmental Disabilities 261QD1600X 224141 New York

Profile Details

NPI number 1750469912
LBN Legal business name State Of New York Comptrollers Office
DBA Doing business as Ibr George A Jervis Clinic
Authorized official Jefferson, Earl
Entity Organization
Organization subpart 1 Yes
Enumeration date Nov 2nd, 2006
Last updated Dec 28th, 2015 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750469912 NPPES
New York MEDICAID 00869952
New York Other 224141

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