Provider Demographics
NPI:1548677883
Name:SENIOR WHOLE HEALTH OF NEW YORK, INC
Entity type:Organization
Organization Name:SENIOR WHOLE HEALTH OF NEW YORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THURMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-494-5353
Mailing Address - Street 1:58 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-2128
Mailing Address - Country:US
Mailing Address - Phone:617-494-5353
Mailing Address - Fax:
Practice Address - Street 1:111 BROADWAY RM 1505
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1926
Practice Address - Country:US
Practice Address - Phone:617-494-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization