Healthcare Provider Details

I. General information

NPI: 1871330910
Provider Name (Legal Business Name): MAEFAIR ACQUISITION OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAEFAIR CT
TRUMBULL CT
06611-4871
US

IV. Provider business mailing address

20 E SUNRISE HWY FL 2
VALLEY STREAM NY
11581-1260
US

V. Phone/Fax

Practice location:
  • Phone: 203-459-5152
  • Fax: 203-459-5156
Mailing address:
  • Phone: 516-705-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MARC EPHRAM OSTREICHER
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-705-4806