NPIMap

Organization Active NPI

Essex County Chapter, Nysarc, Inc.

Doing business as Mountain Lake Services

  • Early Intervention Provider Agency
  • Port Henry, NY
National Provider Identifier
1427134451
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
150901880216 Issued in NY
Legal business name
ESSEX COUNTY CHAPTER, NYSARC, INC.
Doing business as
Mountain Lake Services
Practice address
10 St. Patrick's Place
Port Henry, NY 12974
Phone
(518) 546-3051
Fax
(518) 546-3094
NPI assigned
Oct 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Authorized official

Name
Mr. Martin Joseph Nephew
Title
Executive Director
Phone
(518) 546-3381

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 150901880216 NY Primary
Developmental Disabilities Clinic/Center 261QD1600X NY

Addresses

Primary practice location

10 St. Patrick's Place
Port Henry, NY 12974

Mailing address

10 St. Patrick's Place
Port Henry, NY 12974
Phone (518) 546-3051

Other identifiers 3

IdentifierTypeStateIssuer
6763301OtherNYOPERATING CERTIFICATE #
01276842MedicaidNY
03OtherNYLOCATOR CODE

Other names 1

  • Mountain Lake Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160607002311 NY Part B Supplier - Clinic/Group Practice 9133419948 Receives reassigned benefits from 13 practitioners
Practice locations: Canton, NY; Port Henry, NY; Plattsburgh, NY; Lake Clear, NY; Norwood, NY; Keeseville, NY

National Provider Directory

National Provider Directory
Tax ID family
Essex County Chapter Nysarc Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

63 S Main St
#1-2
Norwood, NY 13668
Phone (315) 353-6618

9 Industrial Blvd
Plattsburgh, NY 12901
Phone (518) 563-0037

279 New York Rd
Plattsburgh, NY 12903
Phone (518) 324-8180

10 St Patrick Pl
Port Henry, NY 12974
Phone (518) 546-3381

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1427134451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 ST. PATRICK'S PLACE",
            "city": "PORT HENRY",
            "state": "NY",
            "postal_code": "12974",
            "telephone_number": "518-546-3051",
            "fax_number": "518-546-3094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 ST. PATRICK'S PLACE",
            "city": "PORT HENRY",
            "state": "NY",
            "postal_code": "12974",
            "telephone_number": "518-546-3051",
            "fax_number": "518-546-3094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSEX COUNTY CHAPTER, NYSARC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "NEPHEW",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "518-546-3381",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NY",
            "license": "150901880216",
            "primary": true
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPERATING CERTIFICATE #",
            "identifier": "6763301",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01276842",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LOCATOR CODE",
            "identifier": "03",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Lake Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Henry, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.