Healthcare Provider Details

I. General information

NPI: 1982913109
Provider Name (Legal Business Name): BORO PARK OPERATING CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 10TH AVE
BROOKLYN NY
11219-3301
US

IV. Provider business mailing address

4770 WHITE PLAINS RD 3 FL
BRONX NY
10470-1104
US

V. Phone/Fax

Practice location:
  • Phone: 718-851-3700
  • Fax:
Mailing address:
  • Phone: 718-931-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7001394N
License Number StateNY

VIII. Authorized Official

Name: MR. KENNETH ROZENBERG
Title or Position: MEMBER
Credential:
Phone: 718-931-9700