Provider Demographics
NPI:1346386653
Name:PROVIDER HAMASPIK OF ORANGE COUNTY
Entity type:Organization
Organization Name:PROVIDER HAMASPIK OF ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MEYER
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-774-8400
Mailing Address - Street 1:1 HAMASPIK WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950
Mailing Address - Country:US
Mailing Address - Phone:845-774-8400
Mailing Address - Fax:845-783-2107
Practice Address - Street 1:10 DINEV COURT
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950
Practice Address - Country:US
Practice Address - Phone:845-774-8811
Practice Address - Fax:845-774-7982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMMIS01448493Medicaid