1871760405 NPI number — NYSARC INC SUFFOLK CHAPTER

Table of content: (NPI 1871760405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871760405 NPI number — NYSARC INC SUFFOLK CHAPTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYSARC INC SUFFOLK 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:
SUFFOLK AHRC
Provider Other Organization Name Type Code:
5
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:
1871760405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 VETERANS MEMORIAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOHEMIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11716-1022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-585-0100
Provider Business Mailing Address Fax Number:
631-585-0233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 VETERANS MEMORIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOHEMIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11716-1022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-585-0100
Provider Business Practice Location Address Fax Number:
631-585-0233
Provider Enumeration Date:
05/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEONARDI
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
631-585-0100

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00807956 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".