1023184173 NPI number — ERNH CORPORATION INC

Table of content: (NPI 1023184173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023184173 NPI number — ERNH CORPORATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERNH CORPORATION INC
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:
EAST ROCKAWAY PROGRESSIVE CARE FACILITY
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:
1023184173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 ATLANTIC AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNBROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-599-2744
Provider Business Mailing Address Fax Number:
516-299-0339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 ATLANTIC AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNBROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-599-2744
Provider Business Practice Location Address Fax Number:
516-299-0339
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POLIMENI
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
516-671-4100

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2911302N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00312969 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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