Provider Demographics
NPI:1982613428
Name:CORAM HEALTHCARE CORPORATION OF N Y
Entity Type:Organization
Organization Name:CORAM HEALTHCARE CORPORATION OF N Y
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-292-4973
Mailing Address - Street 1:701 TECHNOLOGY DR STE 250
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9529
Mailing Address - Country:US
Mailing Address - Phone:724-873-7870
Mailing Address - Fax:949-639-6623
Practice Address - Street 1:375 N FRENCH RD
Practice Address - Street 2:SUITE 108
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2009
Practice Address - Country:US
Practice Address - Phone:716-691-3000
Practice Address - Fax:716-691-5093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM HEALTHCARE CORPORATION OF NEW YORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9694L002251E00000X, 251F00000X, 261QI0500X
NY022522332BP3500X, 333600000X, 3336C0003X, 3336H0001X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3305085OtherNCDPD
NY3305085OtherPHARMACY PERMIT
NY3305085OtherPHARMACY PERMIT
BC4481583OtherDEA