Healthcare Provider Details

I. General information

NPI: 1720226129
Provider Name (Legal Business Name): NYSARC, INC. - SUFFOLK CHAPTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 VETERANS MEMORIAL HWY
BOHEMIA NY
11716-1022
US

IV. Provider business mailing address

2900 VETERANS MEMORIAL HWY
BOHEMIA NY
11716-1022
US

V. Phone/Fax

Practice location:
  • Phone: 631-585-0100
  • Fax: 631-585-0233
Mailing address:
  • Phone: 631-585-0100
  • Fax: 631-585-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. WILLIAM J. LEONARDI
Title or Position: CONTROLLER
Credential:
Phone: 631-585-0100