Healthcare Provider Details

I. General information

NPI: 1306784152
Provider Name (Legal Business Name): INDEPENDENCE CARE SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E FORDHAM RD FL 12
BRONX NY
10458-5059
US

IV. Provider business mailing address

169 MADISON AVE STE 15744
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 877-427-2525
  • Fax: 212-584-5555
Mailing address:
  • Phone: 877-427-2525
  • Fax: 212-584-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: KERRI O'NEILL
Title or Position: CFO
Credential:
Phone: 646-831-7215