Healthcare Provider Details

I. General information

NPI: 1023452141
Provider Name (Legal Business Name): DITMAS PARK ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 E 22ND ST
BROOKLYN NY
11226-6902
US

IV. Provider business mailing address

2107 DITMAS AVE
BROOKLYN NY
11226-6903
US

V. Phone/Fax

Practice location:
  • Phone: 718-907-8560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SANDOR OBERLANDER
Title or Position: CHAIRMAN
Credential:
Phone: 718-907-8560