| |
36 Laurel Ave South Fallsburg NY 12779-5804 | |
(845) 354-9300 | |
Not Available |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 36 Laurel Ave, South Fallsburg, New York |
Authorized Official Name and Position | Chanie Sternberg (PRESIDENT/CEO) |
Authorized Official Contact | 8453549300 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
728 N Main St New Square NY 10977-8916 Ph: (884) 354-9300 | 36 Laurel Ave South Fallsburg NY 12779-5804 Ph: (845) 354-9300 |
NPI Number | 1649618067 |
---|---|
Provider Enumeration Date | 06/07/2013 |
Last Update Date | 07/03/2013 |
Medicare PECOS PAC ID | 4880584416 |
---|---|
Medicare Enrollment ID | O20130628000102 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649618067 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 4353202R (New York) | Primary |