1558682476 NPI number — NYSARC INC NYC CHAPTER

Table of content: (NPI 1558682476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558682476 NPI number — NYSARC INC NYC CHAPTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYSARC INC NYC CHAPTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558682476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 MAIDEN LN
Provider Second Line Business Mailing Address:
8 FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10038-4812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-780-4459
Provider Business Mailing Address Fax Number:
212-777-4277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 E 126TH STREET
Provider Second Line Business Practice Location Address:
APT 6C
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10035-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-780-2538
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GUNDERSON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
212-780-2665

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 61980505 . This is a "NYS OMRDD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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