NPI 1992070056

Nickjax LLC

Organisation PACE Provider Organization New York, NY

Practice location

Address: 115 E 82nd St 1b, New York, NY 10028-0831
Phone: (212) 738-9264

Authorised official

Name: Richard Mancuso
Title: Executive Director
Phone: (212) 738-9264

Registered specialties

PACE Provider Organization Primary

Agencies Taxonomy 251T00000X

Other Program of All-Inclusive Care for the Elderly (PACE) Provider Organization providers in New York →

Registry record

NPI: 1992070056
Entity type: Organization
NPI issued: 21 Mar 2012
Record last updated: 21 Mar 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.