Provider Demographics
NPI:1396859518
Name:DIGITRACE CARE SERVICES INC
Entity Type:Organization
Organization Name:DIGITRACE CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:IBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-536-7400
Mailing Address - Street 1:200 CORPORATE PL
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3840
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:978-535-9757
Practice Address - Street 1:1983 MARCUS AVE
Practice Address - Street 2:SUITE E-134
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1016
Practice Address - Country:US
Practice Address - Phone:516-326-0629
Practice Address - Fax:516-326-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY69644OtherGHI PPO ALTERNATE
NY5503887OtherGHI PPO
NY27782OtherGHI-HMO
NYAZ00855OtherMEDICAL DRS OF NY
NYP00865528OtherRR MEDICARE
NY8011510OtherCIGNA
NYA2590237OtherOXFORD
NYAZ00855OtherMEDICAL DRS OF NY
NY27782OtherGHI-HMO
NY=========006OtherCHAMPUS