Provider Demographics
NPI:1467969634
Name:ICARE OF NEW YORK IPA LLC
Entity Type:Organization
Organization Name:ICARE OF NEW YORK IPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HANG
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-546-2966
Mailing Address - Street 1:5 PENN PLZ STE 2301
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1810
Mailing Address - Country:US
Mailing Address - Phone:347-931-8999
Mailing Address - Fax:
Practice Address - Street 1:5 PENN PLZ STE 2301
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1810
Practice Address - Country:US
Practice Address - Phone:347-931-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY404652163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty