Provider Demographics
NPI:1851558027
Name:NYSARC INC SUFFOLK CHAPTER
Entity Type:Organization
Organization Name:NYSARC INC SUFFOLK CHAPTER
Other - Org Name:SUFFOLK CHAPTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEONARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-585-0100
Mailing Address - Street 1:2900 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1022
Mailing Address - Country:US
Mailing Address - Phone:631-585-0100
Mailing Address - Fax:631-585-0233
Practice Address - Street 1:2900 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1022
Practice Address - Country:US
Practice Address - Phone:631-585-0100
Practice Address - Fax:631-585-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01904567Medicaid