Healthcare Provider Details

I. General information

NPI: 1205975646
Provider Name (Legal Business Name): NEW YORK OUTPATIENT MANGEMENT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD SUITE 204
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

120 NEWHAM AVE
BRENTWOOD NY
11717-5624
US

V. Phone/Fax

Practice location:
  • Phone: 516-932-0803
  • Fax: 888-552-6176
Mailing address:
  • Phone: 631-813-2143
  • Fax: 888-552-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberCP2712
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CYNDI L GREENE
Title or Position: MANAGED CARE DIRECTOR
Credential:
Phone: 631-813-2143