Provider Demographics
NPI:1487835096
Name:NYSARC INC NYC CHAPTER
Entity Type:Organization
Organization Name:NYSARC INC NYC CHAPTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-780-2692
Mailing Address - Street 1:83 MAIDEN LN
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:212-780-2631
Mailing Address - Fax:212-777-5893
Practice Address - Street 1:16120 89TH AVE
Practice Address - Street 2:APT 3D
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3901
Practice Address - Country:US
Practice Address - Phone:212-780-2538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NYSARC INC NYC CHAPTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06198494315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06198494OtherNYS OMRDD
NY02915066Medicaid