Provider Demographics
NPI:1790093144
Name:RELIACARE ALLIANCE
Entity Type:Organization
Organization Name:RELIACARE ALLIANCE
Other - Org Name:RELIACARE ALLIANCE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MORDECHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-956-9400
Mailing Address - Street 1:199 LEE AVE
Mailing Address - Street 2:STE 876
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-8919
Mailing Address - Country:US
Mailing Address - Phone:212-956-9400
Mailing Address - Fax:718-237-4000
Practice Address - Street 1:63 FLUSHING AVE
Practice Address - Street 2:UNIT 299
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1005
Practice Address - Country:US
Practice Address - Phone:212-956-9400
Practice Address - Fax:718-237-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5803778OtherNCPDP PROVIDER IDENTIFICATION NUMBER