MEDICARE: BRUCKNER FOREVER YOUNG SOCIAL ADULT DAY CARE, INC

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

General Provider Information

NPI Number	:	1558603449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCKNER FOREVER YOUNG SOCIAL ADULT DAY CARE, INC

Provider Business Mailing Address
First Line	:	80 BRUCKNER BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-4492
Country	:	US
Telephone Number	:	347-871-3870
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 BRUCKNER BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-4492
Country	:	US
Telephone Number	:	347-871-3870
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARY NABITOVSKY
Credential	:
Telephone Number	:	215-680-6848

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/19/2013

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