MEDICARE: NYSARC INC NYC CHAPTER

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	315P00000X	Intellectual Disabilities Intermediate Care Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6291458	OTHER	NY	NYS OMRDD OPERATING CERT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578630604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYSARC INC NYC CHAPTER

Provider Business Mailing Address
First Line	:	83 MAIDEN LN
Second Line	:	11 TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10038-4812
Country	:	US
Telephone Number	:	212-780-2631
Fax Number	:	212-777-5893

Provider Business Practice Location Address
First Line	:	1207 DITMAS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-6031
Country	:	US
Telephone Number	:	212-780-2631
Fax Number	:	212-777-5893

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. ROBERT C GOLDSMITH
Credential	:
Telephone Number	:	212-780-2692

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	08/22/2020

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