MEDICARE: MENORAH HOME AND HOSPITAL ADULT DAY PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	7001376N	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487781373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENORAH HOME AND HOSPITAL ADULT DAY PROGRAM

Provider Business Mailing Address
First Line	:	6323 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4742
Country	:	US
Telephone Number	:	718-630-2510
Fax Number	:	718-759-4555

Provider Business Practice Location Address
First Line	:	6202 16TH AVE # 12
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2701
Country	:	US
Telephone Number	:	718-621-3600
Fax Number	:	718-621-1280

Authorized Official
Title or Position	:	SR. VP CHIEF FINANCIAL OFFICER
Name	:	ALEXANDER BALKO
Credential	:
Telephone Number	:	718-491-7221

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	11/10/2014

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