Healthcare Provider Details

I. General information

NPI: 1609497635
Provider Name (Legal Business Name): THE BOARDWALK NH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 SURF AVE
BROOKLYN NY
11224-1913
US

IV. Provider business mailing address

3617 PARSONS BLVD
FLUSHING NY
11354-5931
US

V. Phone/Fax

Practice location:
  • Phone: 718-714-4800
  • Fax: 718-228-8622
Mailing address:
  • Phone: 718-888-5200
  • Fax: 718-228-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOEL EDELSTEIN
Title or Position: CEO
Credential:
Phone: 718-888-5200