1598276305 NPI number — ADVANCE CARE ALLIANCE OF NY INC.

Table of content: (NPI 1598276305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598276305 NPI number — ADVANCE CARE ALLIANCE OF NY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE CARE ALLIANCE OF NY 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:
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:
1598276305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 E 42ND ST STE 1762
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10165-6227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 7TH AVE FL 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-692-2269
Provider Business Practice Location Address Fax Number:
914-368-0173
Provider Enumeration Date:
10/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
NAGY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
833-692-2269

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04998734 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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