Healthcare Provider Details

I. General information

NPI: 1811417827
Provider Name (Legal Business Name): ESSEX COUNTY CHAPTER NYSARC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ST PATRICK PL
PORT HENRY NY
12974-1200
US

IV. Provider business mailing address

10 ST PATRICK PL
PORT HENRY NY
12974-1200
US

V. Phone/Fax

Practice location:
  • Phone: 518-546-3381
  • Fax: 518-546-7138
Mailing address:
  • Phone: 518-546-3381
  • Fax: 518-546-7138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number15090188021
License Number StateNY

VIII. Authorized Official

Name: MR. MARTIN J NEPHEW
Title or Position: EXECUTIVE DIRECTOR
Credential: EXECUTIVE DIRECTOR
Phone: 518-546-3381