MEDICARE: SELFHELP ALZHEIMERS RESOURCE PROGRAM

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	251T00000X	PACE Provider Organization

General Provider Information

NPI Number	:	1861770547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELFHELP ALZHEIMERS RESOURCE PROGRAM

Provider Business Mailing Address
First Line	:	520 EIGHTH AVENUE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-6553
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 EIGHTH AVENUE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-6553
Country	:	US
Telephone Number	:	212-971-7600
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT, ADMINISTRATION
Name	:	MR. RUSSELL LUSAK
Credential	:
Telephone Number	:	212-971-7707

Provider Enumeration Date	:	07/28/2011
Last Update Date	:	07/28/2011

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