Healthcare Provider Details

I. General information

NPI: 1699000687
Provider Name (Legal Business Name): MENORAH HOME AND HOSPITAL ADULT DAY PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 ORIENTAL BLVD
BROOKLYN NY
11235-2328
US

IV. Provider business mailing address

6323 7TH AVE
BROOKLYN NY
11220-4742
US

V. Phone/Fax

Practice location:
  • Phone: 718-646-4441
  • Fax:
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 Number7001372N
License Number StateNY

VIII. Authorized Official

Name: ALEXANDER BALKO
Title or Position: SENIOR VP CFO
Credential:
Phone: 718-491-7221