Provider Demographics
NPI:1558682476
Name:NYSARC INC NYC CHAPTER
Entity Type:Organization
Organization Name:NYSARC INC NYC CHAPTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUNDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-780-2665
Mailing Address - Street 1:83 MAIDEN LN
Mailing Address - Street 2:8 FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4812
Mailing Address - Country:US
Mailing Address - Phone:212-780-4459
Mailing Address - Fax:212-777-4277
Practice Address - Street 1:126 E 126TH STREET
Practice Address - Street 2:APT 6C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1702
Practice Address - Country:US
Practice Address - Phone:212-780-2538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY61980505OtherNYS OMRDD