Provider Demographics
NPI:1568513083
Name:ACN GROUP IPA OF NEWYORK
Entity Type:Organization
Organization Name:ACN GROUP IPA OF NEWYORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-797-4821
Mailing Address - Street 1:PO BOX 5600
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-5600
Mailing Address - Country:US
Mailing Address - Phone:845-382-6100
Mailing Address - Fax:845-382-1341
Practice Address - Street 1:505 BOICES LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1083
Practice Address - Country:US
Practice Address - Phone:845-382-6100
Practice Address - Fax:845-382-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management