Organization
CORAM HEALTHCARE CORPORATION OF NEW YORK
Active
Parent organization
CORAM HEALTHCARE CORPORATION OF NEW YORK
Organization subpart
Yes
Provider details
NPI number
Legal business name
CORAM HEALTHCARE CORPORATION OF NEW YORK
Authorized official
VITO PONZIO, JR. (SR VP)
(303) 672-8631
Entity
Organization
Contact information
Practice address
2949 ERIE BLVD E, SUITE 103, SYRACUSE, NY 13224-1442
(315) 425-8028
(315) 425-0989
Mailing address
1675 BROADWAY, SUITE 900, DENVER, CO 80202-4675
(303) 672-8631
(303) 298-0047
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
9694L003
NY
251F00000X
Home Infusion Agency
9694L003
NY
261QI0500X
Infusion Therapy Clinic/Center
N/A
NY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
17027989
NY
333600000X
Pharmacy
17027989
NY
3336C0003X
Community/Retail Pharmacy
17027989
NY
3336H0001X
Home Infusion Therapy Pharmacy
Primary
17027989
NY
3336M0002X
Mail Order Pharmacy
17027989
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17027989
RX LICENSE
NY
01
—
3305011
NCPDP
—
01
—
9694L003
HOME HEALTH AGENCY
NY
Enumeration date
10/18/2006
Last updated
03/07/2023
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