1376902734 NPI number — NYSARC INC MONTGOMERY COUNTY CHAPTER LIBERTY

Table of content: (NPI 1376902734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376902734 NPI number — NYSARC INC MONTGOMERY COUNTY CHAPTER LIBERTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYSARC INC MONTGOMERY COUNTY CHAPTER LIBERTY
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:
1376902734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 LIBERTY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMSTERDAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12010-5635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-954-3346
Provider Business Mailing Address Fax Number:
518-954-3308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 LIBERTY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMSTERDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-954-2027
Provider Business Practice Location Address Fax Number:
518-954-2009
Provider Enumeration Date:
02/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SAUNDERS
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
518-954-3223

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00644606 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02621043 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02247652 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02700049 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03588281 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01494471 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02171800 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02247698 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02416264 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02245476 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02714189 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02599411 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02061801 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02617792 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01385217 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01750518 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02002115 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02924252 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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