Provider Demographics
NPI:1679859904
Name:AFFINITY HEALTH PLAN
Entity Type:Organization
Organization Name:AFFINITY HEALTH PLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUESTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-247-5678
Mailing Address - Street 1:2500 HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3637
Mailing Address - Country:US
Mailing Address - Phone:866-247-5678
Mailing Address - Fax:
Practice Address - Street 1:2500 HALSEY ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3637
Practice Address - Country:US
Practice Address - Phone:866-247-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00477156302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization