1386893998 NPI number — THERALINK 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 1386893998 NPI number — THERALINK OF NEW YORK INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERALINK 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:
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:
1386893998
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35795 STATE ROUTE 126
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARTHAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13619-3303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-493-9328
Provider Business Mailing Address Fax Number:
315-493-1216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
377 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-5301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-562-1790
Provider Business Practice Location Address Fax Number:
845-562-1790
Provider Enumeration Date:
09/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCCOY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS DIRECTOR
Authorized Official Telephone Number:
845-562-1790

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02991968 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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