Healthcare Provider Details

I. General information

NPI: 1124461256
Provider Name (Legal Business Name): SILVER AGE CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 BRUCKNER BLVD
BRONX NY
10454-4414
US

IV. Provider business mailing address

14 BRUCKNER BLVD
BRONX NY
10454-4414
US

V. Phone/Fax

Practice location:
  • Phone: 718-414-2427
  • Fax:
Mailing address:
  • Phone: 718-414-2427
  • 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: ALEXANDER YUSUPOV
Title or Position: PRESIDENT
Credential:
Phone: 212-581-2500