Provider Demographics
NPI:1720245632
Name:NYSARC INC NYC CHAPTER
Entity Type:Organization
Organization Name:NYSARC INC NYC CHAPTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:BENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-780-2500
Mailing Address - Street 1:83 MAIDEN LN
Mailing Address - Street 2:11 TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4812
Mailing Address - Country:US
Mailing Address - Phone:212-780-2500
Mailing Address - Fax:212-777-5893
Practice Address - Street 1:4377 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1397
Practice Address - Country:US
Practice Address - Phone:212-780-2631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01255265Medicaid