MEDICARE: THERALINK OF NEW YORK 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	261QR0400X	Rehabilitation Clinic/Center

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	:	1386893998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERALINK OF NEW YORK INC.

Provider Business Mailing Address
First Line	:	35795 STATE ROUTE 126
Second Line	:
City	:	CARTHAGE
State	:	NY
Zip	:	13619-3303
Country	:	US
Telephone Number	:	315-493-9328
Fax Number	:	315-493-1216

Provider Business Practice Location Address
First Line	:	377 BROADWAY
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-5301
Country	:	US
Telephone Number	:	845-562-1790
Fax Number	:	845-562-1790

Authorized Official
Title or Position	:	BUSINESS DIRECTOR
Name	:	DR. DAVID MCCOY
Credential	:
Telephone Number	:	845-562-1790

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/18/2008

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