Provider Demographics
NPI:1427134451
Name:ESSEX COUNTY CHAPTER, NYSARC, INC.
Entity type:Organization
Organization Name:ESSEX COUNTY CHAPTER, NYSARC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NEPHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-546-3381
Mailing Address - Street 1:10 ST. PATRICK'S PLACE
Mailing Address - Street 2:
Mailing Address - City:PORT HENRY
Mailing Address - State:NY
Mailing Address - Zip Code:12974
Mailing Address - Country:US
Mailing Address - Phone:518-546-3051
Mailing Address - Fax:518-546-3094
Practice Address - Street 1:10 ST. PATRICK'S PLACE
Practice Address - Street 2:
Practice Address - City:PORT HENRY
Practice Address - State:NY
Practice Address - Zip Code:12974
Practice Address - Country:US
Practice Address - Phone:518-546-3051
Practice Address - Fax:518-546-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150901880216252Y00000X
NY261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6763301OtherOPERATING CERTIFICATE #
NY01276842Medicaid
NY03OtherLOCATOR CODE