Provider Demographics
NPI:1114130291
Name:AMERITA OF NEW YORK, LLC.
Entity Type:Organization
Organization Name:AMERITA OF NEW YORK, LLC.
Other - Org Name:AMERITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP MANAGED CARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILOLAHTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-282-2382
Mailing Address - Street 1:6912 S QUENTIN ST STE 50
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4531
Mailing Address - Country:US
Mailing Address - Phone:720-282-5325
Mailing Address - Fax:877-676-0493
Practice Address - Street 1:75 NASSAU TERMINAL RD STE 100
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4997
Practice Address - Country:US
Practice Address - Phone:516-725-5944
Practice Address - Fax:516-280-1073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERITA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023601251F00000X, 332BP3500X
NY0708L001251J00000X
332B00000X, 3336H0001X, 335G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNCPDPOther3317092
NY01815512Medicaid