Provider Demographics
NPI:1396207528
Name:ONY CARE OF NY II, LLC
Entity Type:Organization
Organization Name:ONY CARE OF NY II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LELAND HUTTON
Authorized Official - Last Name:EADIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-733-2064
Mailing Address - Street 1:102 WOODMONT BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2216
Mailing Address - Country:US
Mailing Address - Phone:615-386-0064
Mailing Address - Fax:
Practice Address - Street 1:1131 ROUTE 55 STE 1B
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5054
Practice Address - Country:US
Practice Address - Phone:615-386-0064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty