1659369437 NPI number — CEDAR MANOR

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659369437 NPI number — CEDAR MANOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CEDAR MANOR
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:
6
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:
1659369437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 928
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSSINING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10562-0928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-762-1600
Provider Business Mailing Address Fax Number:
914-762-0437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 CEDAR LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSSINING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10562-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-762-1600
Provider Business Practice Location Address Fax Number:
914-762-0437
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SABATO
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
914-762-1600

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  5905308N , 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: 00309540 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 335185 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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