Provider Demographics
NPI:1376032029
Name:NEW YORK SOCIETY FOR RELIEF OF THE RUPTURED AND CRIPPLED MAINTAINING T
Entity Type:Organization
Organization Name:NEW YORK SOCIETY FOR RELIEF OF THE RUPTURED AND CRIPPLED MAINTAINING T
Other - Org Name:HSS WEST SIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE V.P. & CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-606-1239
Mailing Address - Street 1:535 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4898
Mailing Address - Country:US
Mailing Address - Phone:212-774-2668
Mailing Address - Fax:
Practice Address - Street 1:610 W 58TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1005
Practice Address - Country:US
Practice Address - Phone:212-606-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02996427Medicaid