1427185248 NPI number — ABSOLUT CENTER FOR NURSING AND REHABILITATION AT ENDICOTT, LLC

Table of content: (NPI 1427185248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427185248 NPI number — ABSOLUT CENTER FOR NURSING AND REHABILITATION AT ENDICOTT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUT CENTER FOR NURSING AND REHABILITATION AT ENDICOTT, LLC
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:
Provider Other Organization Name Type Code:
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:
1427185248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 GLEED AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST AURORA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14052-2980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-652-2820
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 NANTUCKET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENDICOTT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13760-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-754-2705
Provider Business Practice Location Address Fax Number:
607-754-2610
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHERMAN
Authorized Official First Name:
ISRAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
716-652-2820

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0302303N , 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: 00030050902 . This is a "EXCELLUS/RMSCO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: BA1017 . This is a "UPSTATE MEDICARE CARRIER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100324 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00949817 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100285 . This is a "EVERCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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