Healthcare Provider Details

I. General information

NPI: 1982613428
Provider Name (Legal Business Name): CORAM HEALTHCARE CORPORATION OF N Y
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N FRENCH RD SUITE 108
AMHERST NY
14228-2009
US

IV. Provider business mailing address

701 TECHNOLOGY DR STE 250
CANONSBURG PA
15317-9529
US

V. Phone/Fax

Practice location:
  • Phone: 716-691-3000
  • Fax: 716-691-5093
Mailing address:
  • Phone: 724-873-7870
  • Fax: 949-639-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number9694L002
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number9694L002
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number9694L002
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number022522
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number022522
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number022522
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number022522
License Number StateNY
# 8
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number022522
License Number StateNY

VIII. Authorized Official

Name: MICHAEL DELL
Title or Position: VICE PRESIDENT
Credential:
Phone: 303-292-4973