Provider Demographics
NPI:1730500687
Name:SKIP OF NEW YORK
Entity Type:Organization
Organization Name:SKIP OF NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:STAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-352-7775
Mailing Address - Street 1:50 VANTAGE POINT DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1180
Mailing Address - Country:US
Mailing Address - Phone:585-352-7775
Mailing Address - Fax:585-352-7879
Practice Address - Street 1:50 VANTAGE POINT DR
Practice Address - Street 2:SUITE 4
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1180
Practice Address - Country:US
Practice Address - Phone:585-352-7775
Practice Address - Fax:585-352-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management