1316983430 NPI number — NYSARC INC PUTNAM COUNTY CHAPTER

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 1316983430 NPI number — NYSARC INC PUTNAM COUNTY CHAPTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYSARC INC PUTNAM COUNTY 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:
PARC
Provider Other Organization Name Type Code:
3
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:
1316983430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 DREWVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10512-3736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-225-5650
Provider Business Mailing Address Fax Number:
845-225-0758

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1938 RT. 6
Provider Second Line Business Practice Location Address:
PARC CENTER
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-225-5650
Provider Business Practice Location Address Fax Number:
845-228-0758
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIB
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
CHIEF CLINICAL OFFICER
Authorized Official Telephone Number:
845-338-1234

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  7024300 , 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: 02698199 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com