Healthcare Provider Details

I. General information

NPI: 1104059856
Provider Name (Legal Business Name): PARKSHORE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 ROCKAWAY PKWY
BROOKLYN NY
11236-4001
US

IV. Provider business mailing address

1555 ROCKAWAY PKWY
BROOKLYN NY
11236-4001
US

V. Phone/Fax

Practice location:
  • Phone: 718-927-6300
  • Fax: 718-272-2166
Mailing address:
  • Phone: 718-927-6300
  • Fax: 718-272-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001385N
License Number StateNY

VIII. Authorized Official

Name: BARRY FRIEDMAN
Title or Position: CEO
Credential:
Phone: 718-927-6300