Provider Demographics
NPI:1386893998
Name:THERALINK OF NEW YORK INC.
Entity type:Organization
Organization Name:THERALINK OF NEW YORK INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-562-1790
Mailing Address - Street 1:35795 STATE ROUTE 126
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-3303
Mailing Address - Country:US
Mailing Address - Phone:315-493-9328
Mailing Address - Fax:315-493-1216
Practice Address - Street 1:377 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5301
Practice Address - Country:US
Practice Address - Phone:845-562-1790
Practice Address - Fax:845-562-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02991968Medicaid