Healthcare Provider Details

I. General information

NPI: 1497994800
Provider Name (Legal Business Name): DITMAS PARK REHABILITATION & CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 DITMAS AVE
BROOKLYN NY
11226-6903
US

IV. Provider business mailing address

2107 DITMAS AVE
BROOKLYN NY
11226-6903
US

V. Phone/Fax

Practice location:
  • Phone: 718-462-8100
  • Fax: 718-941-6051
Mailing address:
  • Phone: 718-462-8100
  • Fax: 718-941-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPENDING
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SHABSE OBERLANDER
Title or Position: PARTNER
Credential:
Phone: 718-462-8100