Provider Demographics
NPI:1427113547
Name:NYSARC INC.
Entity type:Organization
Organization Name:NYSARC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COURTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-363-3389
Mailing Address - Street 1:701 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-1500
Mailing Address - Country:US
Mailing Address - Phone:315-363-9281
Mailing Address - Fax:315-363-9286
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-1648
Practice Address - Country:US
Practice Address - Phone:315-363-9281
Practice Address - Fax:315-363-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01454957Medicaid
NY56071AMedicare PIN