Healthcare Provider Details

I. General information

NPI: 1528113974
Provider Name (Legal Business Name): THERACARE OF NEW YORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W 32ND ST 8TH FLOOR
NEW YORK NY
10001-3212
US

IV. Provider business mailing address

116 W 32ND ST 8TH FLOOR
NEW YORK NY
10001-3212
US

V. Phone/Fax

Practice location:
  • Phone: 212-564-2350
  • Fax: 212-564-2578
Mailing address:
  • Phone: 212-564-2350
  • Fax: 212-564-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN CALDERON
Title or Position: PRESIDENT
Credential:
Phone: 212-564-2350