Provider Demographics
NPI:1902872591
Name:HASC DIAGNOSTIC &TREATMENT CENTER, INC
Entity Type:Organization
Organization Name:HASC DIAGNOSTIC &TREATMENT CENTER, INC
Other - Org Name:BLANCHE KAHN FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKSLAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-434-4600
Mailing Address - Street 1:5601 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2517
Mailing Address - Country:US
Mailing Address - Phone:718-745-7575
Mailing Address - Fax:718-745-7596
Practice Address - Street 1:1221 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4803
Practice Address - Country:US
Practice Address - Phone:718-434-4600
Practice Address - Fax:718-434-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001298R261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02186092Medicaid
NY02186092Medicaid