Provider Demographics
NPI:1205975646
Name:NEW YORK OUTPATIENT MANGEMENT SERVICE
Entity type:Organization
Organization Name:NEW YORK OUTPATIENT MANGEMENT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-813-2143
Mailing Address - Street 1:120 NEWHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-5624
Mailing Address - Country:US
Mailing Address - Phone:631-813-2143
Mailing Address - Fax:888-552-6176
Practice Address - Street 1:100 MANETTO HILL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1311
Practice Address - Country:US
Practice Address - Phone:516-932-0803
Practice Address - Fax:888-552-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCP2712332BC3200X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4815110001Medicare ID - Type Unspecified