Healthcare Provider Details

I. General information

NPI: 1851940597
Provider Name (Legal Business Name): SHANTI NIKETAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236-03 BRADDOCK SHANTINIKETAN - A SENIOR DAY CARE CENTER
BELLEROSE NY
11426
US

IV. Provider business mailing address

76-18 266TH STREET
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 718-781-0885
  • Fax:
Mailing address:
  • Phone: 718-740-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHANMUGAN SRIDHAR
Title or Position: BOARD MEMBER
Credential:
Phone: 718-740-9400