Healthcare Provider Details

I. General information

NPI: 1093620528
Provider Name (Legal Business Name): INDEPENDENT SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CRYSTAL ST
MONTICELLO NY
12701-1380
US

IV. Provider business mailing address

20 CRYSTAL ST
MONTICELLO NY
12701-1380
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-5218
  • Fax: 845-794-8168
Mailing address:
  • Phone: 845-794-5218
  • Fax: 845-794-8168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: LAURIE CIRILLO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 845-794-5218