1114967924 NPI number — HOME AIDE SERVICE OF EASTERN NEW YORK, INC.

Table of content: (NPI 1114967924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114967924 NPI number — HOME AIDE SERVICE OF EASTERN NEW YORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME AIDE SERVICE OF EASTERN 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:
6
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:
1114967924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 RIVER ST
Provider Second Line Business Mailing Address:
SUITE 3000
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12180-2238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-274-6200
Provider Business Mailing Address Fax Number:
518-274-1829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 RIVER ST
Provider Second Line Business Practice Location Address:
SUITE 3000
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-274-6200
Provider Business Practice Location Address Fax Number:
518-274-1829
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAZZACCO
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
VP/DIRECTOR
Authorized Official Telephone Number:
518-270-1310

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1921601 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: 1921901L , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000400078000 . This is a "BSNENY, SR BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10002765 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7408289 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 004116 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 990069 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00872739 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3503 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040401000507 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00896511 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 702486 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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