MEDICARE: NYSARC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD1600X	Developmental Disabilities Clinic/Center	7014305	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205001138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYSARC INC

Provider Business Mailing Address
First Line	:	1000 ELMWOOD AVE
Second Line	:	SUITE 500
City	:	ROCHESTER
State	:	NY
Zip	:	14620-3042
Country	:	US
Telephone Number	:	585-271-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1387 FAIRPORT RD
Second Line	:	BUILDING 1100
City	:	FAIRPORT
State	:	NY
Zip	:	14450-2003
Country	:	US
Telephone Number	:	585-641-0304
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MS. BARBARA S WALE
Credential	:
Telephone Number	:	585-672-2233

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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