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General NPI Number Information
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NPI Number | 1811417827
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Entity Type | Organization
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Legal Business Name | ESSEX COUNTY CHAPTER NYSARC, INC
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10 ST PATRICK PL
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City | PORT HENRY
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State | NY
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Zip | 12974-1200
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Country | US
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Telephone | 518-546-3381
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Fax | 518-546-7138
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Provider Business Mailing Address
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Address Line | 10 ST PATRICK PL
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City | PORT HENRY
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State | NY
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Zip | 12974-1200
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Country | US
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Telephone | 518-546-3381
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Fax | 518-546-7138
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MARTIN J NEPHEW
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Credential | EXECUTIVE DIRECTOR
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Telephone | 518-546-3381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 15090188021
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License Number State | NY
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