MEDICARE: INDEPENDENCE CARE SYSTEM, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316342603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE CARE SYSTEM, INC.

Provider Business Mailing Address
First Line	:	169 MADISON AVE STE 15744
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-5101
Country	:	US
Telephone Number	:	877-427-2525
Fax Number	:	212-584-2555

Provider Business Practice Location Address
First Line	:	400 E FORDHAM RD FL 10
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5059
Country	:	US
Telephone Number	:	877-427-2525
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	KERRI O'NEILL
Credential	:
Telephone Number	:	646-831-7215

Provider Enumeration Date	:	10/29/2014
Last Update Date	:	03/31/2026

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