=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386893998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERALINK OF NEW YORK INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2008
-----------------------------------------------------
Last Update Date | 09/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 377 BROADWAY
-----------------------------------------------------
City | NEWBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12550-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-562-1790
-----------------------------------------------------
Fax | 845-562-1790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35795 STATE ROUTE 126
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13619-3303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-493-9328
-----------------------------------------------------
Fax | 315-493-1216
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS DIRECTOR
-----------------------------------------------------
Name | DR. DAVID MCCOY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-562-1790
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------