Provider Demographics
NPI:1043414170
Name:NYSARC INC.
Entity type:Organization
Organization Name:NYSARC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-331-7741
Mailing Address - Street 1:150 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1238
Mailing Address - Country:US
Mailing Address - Phone:315-331-7741
Mailing Address - Fax:
Practice Address - Street 1:150 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1238
Practice Address - Country:US
Practice Address - Phone:315-331-7741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60530473261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02870395Medicaid