Healthcare Provider Details

I. General information

NPI: 1063454494
Provider Name (Legal Business Name): IRVINGTON HEALTHCARE PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 40TH ST
IRVINGTON NJ
07111-1184
US

IV. Provider business mailing address

170 53RD ST 3RD FLOOR
BROOKLYN NY
11232-4319
US

V. Phone/Fax

Practice location:
  • Phone: 973-371-7878
  • Fax: 973-371-4081
Mailing address:
  • Phone: 718-567-0400
  • Fax: 718-567-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060736
License Number StateNJ

VIII. Authorized Official

Name: MR. SAM STERN
Title or Position: COMPTROLLER
Credential:
Phone: 718-576-0400