1558682476 NPI number — NYSARC INC NYC 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 1558682476 NPI number — NYSARC INC NYC CHAPTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYSARC INC NYC 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:
Provider Other Organization Name Type Code:
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:
1558682476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 MAIDEN LN
Provider Second Line Business Mailing Address:
8 FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10038-4812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-780-4459
Provider Business Mailing Address Fax Number:
212-777-4277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 E 126TH STREET
Provider Second Line Business Practice Location Address:
APT 6C
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10035-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-780-2538
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUNDERSON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
212-780-2665

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 61980505 . This is a "NYS OMRDD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".