Provider Demographics
NPI:1619161585
Name:CHOICE OF NEW ROCHELLE, INC.
Entity Type:Organization
Organization Name:CHOICE OF NEW ROCHELLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:H
Authorized Official - Last Name:FESSENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:914-576-0173
Mailing Address - Street 1:420 NORTH AVE
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4160
Mailing Address - Country:US
Mailing Address - Phone:914-576-0173
Mailing Address - Fax:
Practice Address - Street 1:420 NORTH AVE
Practice Address - Street 2:FLOOR 2
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4160
Practice Address - Country:US
Practice Address - Phone:914-576-0173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02152981Medicaid