MEDICARE: REGENCY OF BORO PARK

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	310400000X	Assisted Living Facility	331F268	NY

General Provider Information

NPI Number	:	1871796045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY OF BORO PARK

Provider Business Mailing Address
First Line	:	5110 19TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1703
Country	:	US
Telephone Number	:	718-223-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 19TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1703
Country	:	US
Telephone Number	:	718-223-1800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SAM MOSKOWITZ
Credential	:
Telephone Number	:	718-223-1800

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	08/22/2020

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