MEDICARE: EASTER SEALS 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	385H00000X	Respite Care
2	310500000X	Mental Illness Intermediate Care Facility

General Provider Information

NPI Number	:	1679024210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTER SEALS NEW YORK, INC

Provider Business Mailing Address
First Line	:	633 3RD AVE FL 6
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-6733
Country	:	US
Telephone Number	:
Fax Number	:	866-834-4570

Provider Business Practice Location Address
First Line	:	304 DALEY BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-3848
Country	:	US
Telephone Number	:	585-957-7206
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MS. CAROL KHOURY
Credential	:
Telephone Number	:	585-957-9202

Provider Enumeration Date	:	10/19/2016
Last Update Date	:	04/03/2026

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