Healthcare Provider Details

I. General information

NPI: 1942648613
Provider Name (Legal Business Name): ST. MARKS BROOKLYN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 SAINT MARKS AVE
BROOKLYN NY
11213
US

IV. Provider business mailing address

691 92ND ST FL 2
BROOKLYN NY
11228-3619
US

V. Phone/Fax

Practice location:
  • Phone: 718-467-7300
  • Fax: 718-467-0103
Mailing address:
  • Phone: 347-560-2238
  • Fax: 347-269-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001398N
License Number StateNY

VIII. Authorized Official

Name: MR. SOLOMON RUBIN
Title or Position: CEO
Credential:
Phone: 347-560-2238