Healthcare Provider Details

I. General information

NPI: 1487781373
Provider Name (Legal Business Name): MENORAH HOME AND HOSPITAL ADULT DAY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 16TH AVE # 12
BROOKLYN NY
11204-2701
US

IV. Provider business mailing address

6323 7TH AVE
BROOKLYN NY
11220-4742
US

V. Phone/Fax

Practice location:
  • Phone: 718-621-3600
  • Fax: 718-621-1280
Mailing address:
  • Phone: 718-630-2510
  • Fax: 718-759-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number7001376N
License Number StateNY

VIII. Authorized Official

Name: ALEXANDER BALKO
Title or Position: SR. VP CHIEF FINANCIAL OFFICER
Credential:
Phone: 718-491-7221