Basic Information
| Provider Information | |||||||||
| NPI: | 1427489723 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUPPLEMENTAL HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 STONEWELL RD | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115701721 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 551 5TH AVE | ||||||||
| Address2: | SUITE 1923 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101760001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6467765675 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2013 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | INDIG | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF SCHOOL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 6467765675 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | 791437131 | NY | Y | Agencies | Local Education Agency (LEA) |
No ID Information.