1548427974 NPI number — WELLCARE OF NEW YORK, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548427974 NPI number — WELLCARE OF NEW YORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLCARE OF NEW YORK, INC.
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:
1548427974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8735 HENDERSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33634-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-290-6200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE NEW YORK PLAZA
Provider Second Line Business Practice Location Address:
15TH FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-463-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HABER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP & SECRETARY
Authorized Official Telephone Number:
813-206-1490

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01182503 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02825230 . This is a "ADVOCATE (MLTC)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02825249 . This is a "ADVOCATE COMPLETE (MLTC)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com