| NAME |
STATEN ISLAND CBOC |
| STATE |
NEW YORK |
| STREET ADDR. 1 |
1150 SOUTH AVE, 3RD FLOOR SUITE 301 |
| CITY |
STATEN ISLAND |
| ZIP |
10314-3414 |
| OFFICIAL VA NAME |
STATEN ISLAND CBOC-NYHHCS |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
STATEN ISLAND VA CLINIC |
| ST. ADDR. 1 (MAILING) |
1150 SOUTH AVE, 3RD FLOOR SUITE 301 |
| CITY (MAILING) |
STATEN ISLAND |
| STATE (MAILING) |
NEW YORK |
| ZIP (MAILING) |
10314-3414 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1487693362
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
630GB |
| HISTORY |
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1487693362
-
- CODING SYSTEM: VASTANUM
- ID: 630GB
-
- CODING SYSTEM: CLIA
- ID: 33D1015633
|
