Healthcare Provider Details

I. General information

NPI: 1750609962
Provider Name (Legal Business Name): DIGITRACE CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1983 MARCUS AVE SUITE E-134
NEW HYDE PARK NY
11042-1016
US

IV. Provider business mailing address

200 CORPORATE PL SUITE 5B
PEABODY MA
01960-3840
US

V. Phone/Fax

Practice location:
  • Phone: 516-326-0629
  • Fax:
Mailing address:
  • Phone: 978-536-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARL IBERGER
Title or Position: EVP-CAO
Credential:
Phone: 978-536-7400