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General NPI Number Information
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NPI Number | 1033256615
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Entity Type | Organization
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Legal Business Name | NYSARC INC COLUMBIA COUNTY CHAPTER
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 3100 LAKE ST
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City | VALATIE
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State | NY
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Zip | 12184-2305
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Country | US
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Telephone | 518-672-4451
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2
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City | MELLENVILLE
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State | NY
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Zip | 12544-0002
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Country | US
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Telephone | 518-672-4451
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Fax | 518-672-0187
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KENNETH R STALL
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Credential |
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Telephone | 518-672-4451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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