Provider Demographics
NPI:1184176570
Name:ALLIANCE SERVICES FOR TBI, INC
Entity type:Organization
Organization Name:ALLIANCE SERVICES FOR TBI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-501-2637
Mailing Address - Street 1:24707 JERICHO TPKE
Mailing Address - Street 2:SUITE A3
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1531
Mailing Address - Country:US
Mailing Address - Phone:866-915-7837
Mailing Address - Fax:888-894-0540
Practice Address - Street 1:24707 JERICHO TPKE
Practice Address - Street 2:SUITE A3
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1531
Practice Address - Country:US
Practice Address - Phone:866-915-7837
Practice Address - Fax:888-894-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03053252Medicaid