Provider Demographics
NPI:1457450124
Name:NYSARC INC NYC CHAPTER
Entity Type:Organization
Organization Name:NYSARC INC NYC CHAPTER
Other - Org Name:AHRC NEW YORK CITY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASSOC EXEC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-780-2500
Mailing Address - Street 1:83 MAIDEN LANE
Mailing Address - Street 2:11 TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4812
Mailing Address - Country:US
Mailing Address - Phone:212-780-2500
Mailing Address - Fax:212-777-4277
Practice Address - Street 1:83 MAIDEN LANE
Practice Address - Street 2:5 TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4812
Practice Address - Country:US
Practice Address - Phone:212-780-2580
Practice Address - Fax:212-777-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6103100251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244968Medicaid
WANR71Medicare PIN
NY00244968Medicaid