Healthcare Provider Details

I. General information

NPI: 1508269531
Provider Name (Legal Business Name): GOLDEN YEARS SENIOR PROGRAM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2014
Last Update Date: 03/22/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25820 HILLSIDE AVENUE
FLORAL PARK NY
11004
US

IV. Provider business mailing address

7414 263RD ST FIRST FLOOR
GLEN OAKS NY
11004-1113
US

V. Phone/Fax

Practice location:
  • Phone: 347-739-8732
  • Fax: 718-740-9707
Mailing address:
  • Phone: 347-739-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAYENDRA SHAH
Title or Position: PRESIDENT
Credential:
Phone: 347-739-8732