Healthcare Provider Details

I. General information

NPI: 1851831523
Provider Name (Legal Business Name): IRVINGTON HEALTH CARE PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 40TH ST
IRVINGTON NJ
07111-1184
US

IV. Provider business mailing address

14C 53RD ST SUITE 220
BROOKLYN NY
11232-2644
US

V. Phone/Fax

Practice location:
  • Phone: 877-567-0402
  • Fax: 718-567-0600
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 Number
License Number StateNJ

VIII. Authorized Official

Name: SAM STERN
Title or Position: CFO
Credential:
Phone: 718-567-0400