New York State Catholic Health Plan, Inc.

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

C-027194 Issued in NY

Legal business name

NEW YORK STATE CATHOLIC HEALTH PLAN, INC.

Doing business as

Fidelis Care New York

Practice address

9525 Queens Blvd
8TH FL
Rego Park, NY 11374-4510

Phone

(718) 896-6500

Fax

(718) 896-2755

NPI assigned

Oct 14, 2011

Last updated

Oct 28, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark L Lane

Title

President & Chief Executive Officer

Phone

(718) 896-6500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fidelis Care New York Doing business as

Tax ID family

Fidelis Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Fidelis Care

  • Health Maintenance Organization
  • Getzville, NY
  • NPI 1740600147
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319760000000",
    "number": "1205111861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9525 QUEENS BLVD",
            "address_2": "8TH FL",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744510",
            "telephone_number": "718-896-6500",
            "fax_number": "718-896-2755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9525 QUEENS BLVD",
            "address_2": "8TH FL",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113744510",
            "telephone_number": "718-896-6500",
            "fax_number": "718-896-2755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK STATE CATHOLIC HEALTH PLAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-14",
        "last_updated": "2011-10-28",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "718-896-6500"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "NY",
            "license": "C-027194",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "C-027194",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fidelis Care New York",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Maintenance Organization in Rego Park, NY
• Providers in Rego Park, NY by specialty
• Health Maintenance Organization in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.