Healthcare Provider Details

I. General information

NPI: 1306911722
Provider Name (Legal Business Name): JEWISH HOME LIFECARE HARRY AND JEANETTE WEINBERG CAMPUS BRONX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W KINGSBRIDGE RD ATTN MEDICAL DEPT
BRONX NY
10468-3903
US

IV. Provider business mailing address

100 W KINGSBRIDGE RD ATTN MEDICAL DEPT
BRONX NY
10468-3903
US

V. Phone/Fax

Practice location:
  • Phone: 718-410-1500
  • Fax:
Mailing address:
  • Phone: 718-410-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number7000317N
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number7000317N
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number7000317N
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7000317N
License Number StateNY

VIII. Authorized Official

Name: AUDREY WEINER
Title or Position: CEO
Credential: DSW
Phone: 212-870-4600