Healthcare Provider Details

I. General information

NPI: 1962792044
Provider Name (Legal Business Name): TRI STATE ELDER ADVOCACY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 5TH AVE SUITE P #239
NEW YORK NY
10001-7604
US

IV. Provider business mailing address

244 5TH AVE SUITE P #239
NEW YORK NY
10001-7604
US

V. Phone/Fax

Practice location:
  • Phone: 347-623-0272
  • Fax: 203-286-4057
Mailing address:
  • Phone: 347-623-0272
  • Fax: 203-286-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK KESCHL
Title or Position: PRESIDENT AND ADMINISTRATOR
Credential: LPN, LNHA
Phone: 347-623-0272