Provider Demographics
NPI:1942560537
Name:VILLAGE SENIOR SERVICES CORPORATION
Entity Type:Organization
Organization Name:VILLAGE SENIOR SERVICES CORPORATION
Other - Org Name:VILLAGECAREMAX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-337-5600
Mailing Address - Street 1:154 CHRISTOPHER ST
Mailing Address - Street 2:2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2840
Mailing Address - Country:US
Mailing Address - Phone:212-337-5600
Mailing Address - Fax:212-924-7396
Practice Address - Street 1:154 CHRISTOPHER ST
Practice Address - Street 2:2D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2840
Practice Address - Country:US
Practice Address - Phone:212-337-5600
Practice Address - Fax:212-924-7396
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE CENTER FOR CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03420399Medicaid