Suffolk Outpatient Treatment Program
PFI: T758
Secondary Site ID: 0019
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (631) 351-7113
Fax: (631) 351-0862
Address: 2075 New York Ave, Huntington, NY 11746
County: Suffolk
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (631) 589-9500
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
ACT
PFI: T758
Secondary Site ID: 0023
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 443-0923
Fax:
Address: 988 Myrtle Ave, Brooklyn, NY 11206
County: Kings
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (718) 443-0923
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Cape Road Residential Treatment Program
PFI: T758
Secondary Site ID: 0024
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (845) 647-6575
Fax:
Address: 767 Cape Rd, Ellenville, NY 12428
County: Ulster
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (845) 647-4592
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Fox Run Residential Treatment Program
PFI: T758
Secondary Site ID: 0025
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (845) 516-1000
Fax:
Address: 190 Fox Hollow Rd, Rhinebeck, NY 12572
County: Dutchess
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (845) 516-1000
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Meadow Run Residential Treatment Program
PFI: T758
Secondary Site ID: 0026
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (845) 876-3789
Fax:
Address: 88 Fox Hollow Rd, Rhinebeck, NY 12572
County: Dutchess
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (845) 876-3789
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Jamaica IOP ISSWR Program Lab
PFI: T758
Secondary Site ID: 0000
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 206-1990
Fax: (718) 206-0051
Address: 144-10 Jamaica Avenue, Jamaica, NY 11435
County: Queens
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (718) 206-2000
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Forbell Satellite
PFI: T758
Secondary Site ID: 0015
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (929) 244-1456
Fax: (718) 636-1613
Address: 338 Forbell Avenue, Brooklyn, NY 11208
County: Kings
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (917) 773-7317
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
New Beginnings Community Counseling Center
PFI: T758
Secondary Site ID: 0014
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 665-7112
Fax: (718) 665-1174
Address: 510 Courtlandt Avenue 4th Floor, Bronx, NY 10451
County: Bronx
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (718) 665-2456
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Independence Outpatient Treatment Program
PFI: T758
Secondary Site ID: 0013
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 402-9000
Fax: (718) 665-0803
Address: 510 Courtlandt Avenue 5th Floor, Bronx, NY 10451
County: Bronx
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (917) 773-7317
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Mott Haven - OTP
PFI: T758
Secondary Site ID: 0011
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 292-4640
Fax: (718) 402-5006
Address: 362 East 148th Street, Bronx, NY 10455
County: Bronx
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (718) 292-4640
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Richmond Hill - Residential
PFI: T758
Secondary Site ID: 0001
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 441-8913
Fax: (718) 805-6041
Address: 130-20 89th Road, Richmond Hill, NY 11418
County: Queens
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (718) 441-8913
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Jarrett Place
PFI: T758
Secondary Site ID: 0003
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 681-9300
Fax: (718) 681-8913
Address: 1521 Jarrett Place, Bronx, NY 10461
County: Bronx
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (917) 387-6957
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Van Wyck Admissions and Residential
PFI: T758
Secondary Site ID: 0004
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 657-6195
Fax: (718) 297-9041
Address: 88-83 Van Wyck Expressway, Jamaica, NY 11435
County: Queens
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (718) 647-8010
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Ellenville and Ellenville Women's Vets
PFI: T758
Secondary Site ID: 0005
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (845) 647-4592
Fax: (845) 701-1601
Address: 751 Briggs Hwy, Ellenville, NY 12428
County: Ulster
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (917) 387-6957
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
43rd Veterans
PFI: T758
Secondary Site ID: 0006
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (212) 333-5445
Fax: (212) 307-7382
Address: 327 W 43rd Street, New York, NY 10036
County: New York
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (917) 387-6957
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Ed Thompson
PFI: T758
Secondary Site ID: 0007
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 849-3582
Fax: (718) 850-3914
Address: 130-15 89th Road, Richmond Hill, NY 11418
County: Queens
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (917) 387-6957
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
106 Community Residence
PFI: T758
Secondary Site ID: 0008
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (212) 864-4128
Fax: (212) 663-9193
Address: 68 W 106th Street, New York, NY 10025
County: New York
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (917) 387-6957
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Harlem OP
PFI: T758
Secondary Site ID: 0009
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (212) 864-4128
Fax: (212) 904-1515
Address: 2090 Adam Clayton Powell Blvd-Flr 7, New York, NY 10027
County: New York
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (718) 704-3910
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Grand Concourse Outpatient Treatment Program
PFI: T758
Secondary Site ID: 0010
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 292-4455
Fax: (718) 292-9228
Address: 250 Grand Concourse, Bronx, NY 10451
County: Bronx
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (718) 292-4455
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027
Bronx Outpatient Treatment Program
PFI: T758
Secondary Site ID: 0012
Certification Type: WAIVER
Director: Tatiana Gouskova, M.D.
Phone: (718) 518-9007
Fax: (718) 518-8281
Address: 900 Arnow Avenue, Bronx, NY 10469
County: Bronx
Country: United States
Single or Primary Contact: Charles Madray
Contact Phone: (929) 218-0878
CLIA #: 33D2054034
Tests:
COVID-19 ANTIGEN Breath Alcohol Drugs of Abuse Erythrocyte Sedimentation Rate (ESR) Glucose Occult Blood pH Pregnancy Test (Urine) HIV, Rapid Saliva Alcohol Strep A Test Urinalysis
02/13/2027