Provider Demographics
NPI:1053822825
Name:HERITAGE HEALTH SYSTEMS OF NEW YORK, INC.
Entity Type:Organization
Organization Name:HERITAGE HEALTH SYSTEMS OF NEW YORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-206-1490
Mailing Address - Street 1:44 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4425
Practice Address - Country:US
Practice Address - Phone:800-960-2530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLCARE HEALTH PLANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization