Healthcare Provider Details

I. General information

NPI: 1295980092
Provider Name (Legal Business Name): PUTNAM COUNTY CHAPTER, NYSARC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BALDWIN PLACE RD
MAHOPAC NY
10541-2226
US

IV. Provider business mailing address

31 INTERNATIONAL BLVD TERRAVEST CORPORATE PARK
BREWSTER NY
10509-2343
US

V. Phone/Fax

Practice location:
  • Phone: 845-628-2280
  • Fax: 845-628-0713
Mailing address:
  • Phone: 845-278-7272
  • Fax: 845-278-6781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number00180445DDC
License Number StateNY

VIII. Authorized Official

Name: SUSAN LIMONGELLO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 845-278-7272