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
1811417827
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
15090188021 Issued in NY
Legal business name
ESSEX COUNTY CHAPTER NYSARC, INC
Doing business as
Mountain Lake Services
Practice address
10 St Patrick PL
Port Henry, NY 12974-1200
Phone
(518) 546-3381
Fax
(518) 546-7138
NPI assigned
Jun 21, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Martin J Nephew, EXECUTIVE DIRECTOR
Title
Executive Director
Phone
(518) 546-3381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 15090188021 NY Primary

Addresses

Primary practice location

10 St Patrick PL
Port Henry, NY 12974-1200

Mailing address

10 St Patrick PL
Port Henry, NY 12974-1200
Phone (518) 546-3381

Other identifiers 1

IdentifierTypeStateIssuer
01276842MedicaidNY

Other names 1

  • Mountain Lake Services Doing business as

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.

NPI Registry JSON

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1811417827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 ST PATRICK PL",
            "city": "PORT HENRY",
            "state": "NY",
            "postal_code": "129741200",
            "telephone_number": "518-546-3381",
            "fax_number": "518-546-7138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 ST PATRICK PL",
            "city": "PORT HENRY",
            "state": "NY",
            "postal_code": "129741200",
            "telephone_number": "518-546-3381",
            "fax_number": "518-546-7138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSEX COUNTY CHAPTER NYSARC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-21",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "NEPHEW",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "518-546-3381",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "EXECUTIVE DIRECTOR"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NY",
            "license": "15090188021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01276842",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Lake Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "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 Jul 21, 2022; 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.