1306882857 NPI number — PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION

Table of content: (NPI 1306882857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306882857 NPI number — PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE PARKER JEWISH GERIATRIC INST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306882857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27111 76TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-289-2272
Provider Business Mailing Address Fax Number:
718-289-2274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27111 76TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040-1436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-289-2272
Provider Business Practice Location Address Fax Number:
718-289-2274
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WERNER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SR VP FINANCE/CFO
Authorized Official Telephone Number:
718-289-2354

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 013672 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00313511 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3336662 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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