Healthcare Provider Details

I. General information

NPI: 1518979947
Provider Name (Legal Business Name): CORAM HEALTHCARE CORPORATION OF NEW YORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 JUPITER LN
ALBANY NY
12205-6918
US

IV. Provider business mailing address

1675 BROADWAY SUITE 900
DENVER CO
80202-4675
US

V. Phone/Fax

Practice location:
  • Phone: 518-689-2900
  • Fax: 518-689-2900
Mailing address:
  • Phone: 303-672-8631
  • Fax: 303-298-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number9694L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number9694L001
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number9694L001
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number022519
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number022519
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022519
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number022519
License Number StateNY
# 8
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number022519
License Number StateNY

VIII. Authorized Official

Name: VITO PONZIO JR.
Title or Position: SR VP
Credential:
Phone: 303-672-8631