Healthcare Provider Details

I. General information

NPI: 1174551741
Provider Name (Legal Business Name): SHOREFRONT JEWISH GERIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 W 29TH ST
BROOKLYN NY
11224-1901
US

IV. Provider business mailing address

3015 W 29TH ST
BROOKLYN NY
11224-1901
US

V. Phone/Fax

Practice location:
  • Phone: 718-266-5700
  • Fax:
Mailing address:
  • Phone: 718-266-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001376N
License Number StateNY

VIII. Authorized Official

Name: MR. ALEXANDER BALKO
Title or Position: SENIOR VICE PRESIDENT AND CFO
Credential:
Phone: 718-491-7221