Healthcare Provider Details

I. General information

NPI: 1922004860
Provider Name (Legal Business Name): MENORAH HOME & HOSPITAL FOR THE AGED & INFIRM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 ORIENTAL BLVD
BROOKLYN NY
11235-2328
US

IV. Provider business mailing address

1516 ORIENTAL BLVD
BROOKLYN NY
11235-2328
US

V. Phone/Fax

Practice location:
  • Phone: 718-646-4441
  • Fax:
Mailing address:
  • Phone: 718-646-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001372N
License Number StateNY

VIII. Authorized Official

Name: MR. DAVID WAGNER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 718-491-7209