Healthcare Provider Details

I. General information

NPI: 1427134451
Provider Name (Legal Business Name): ESSEX COUNTY CHAPTER, NYSARC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ST. PATRICK'S PLACE
PORT HENRY NY
12974
US

IV. Provider business mailing address

10 ST. PATRICK'S PLACE
PORT HENRY NY
12974
US

V. Phone/Fax

Practice location:
  • Phone: 518-546-3051
  • Fax: 518-546-3094
Mailing address:
  • Phone: 518-546-3051
  • Fax: 518-546-3094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number150901880216
License Number StateNY

VIII. Authorized Official

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