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General NPI Number Information
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NPI Number | 1205111861
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Entity Type | Organization
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Legal Business Name | NEW YORK STATE CATHOLIC HEALTH PLAN, INC.
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 9525 QUEENS BLVD 8TH FL
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City | REGO PARK
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State | NY
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Zip | 11374-4510
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Country | US
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Telephone | 718-896-6500
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Fax | 718-896-2755
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Provider Business Mailing Address
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Address Line | 9525 QUEENS BLVD 8TH FL
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City | REGO PARK
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State | NY
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Zip | 11374-4510
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Country | US
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Telephone | 718-896-6500
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Fax | 718-896-2755
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | MARK L LANE
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Credential |
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Telephone | 718-896-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | C-027194
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License Number State | NY
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