1306911722 NPI number — JEWISH HOME LIFECARE HARRY AND JEANETTE WEINBERG CAMPUS BRONX

Table of content: (NPI 1306911722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306911722 NPI number — JEWISH HOME LIFECARE HARRY AND JEANETTE WEINBERG CAMPUS BRONX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH HOME LIFECARE HARRY AND JEANETTE WEINBERG CAMPUS BRONX
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:
JEWISH HOME LIFECARE-BRONX MEDICAL DEPARTMENT
Provider Other Organization Name Type Code:
5
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:
1306911722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W KINGSBRIDGE RD
Provider Second Line Business Mailing Address:
ATTN MEDICAL DEPT
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10468-3903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-410-1500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W KINGSBRIDGE RD
Provider Second Line Business Practice Location Address:
ATTN MEDICAL DEPT
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-410-1500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINER
Authorized Official First Name:
AUDREY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
212-870-4600

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  7000317N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X , with the licence number: 7000317N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 7000317N , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 7000317N , 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)





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