Healthcare Provider Details

I. General information

NPI: 1417993387
Provider Name (Legal Business Name): REGO PARK N H LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11126 CORONA AVE
FLUSHING NY
11368-4027
US

IV. Provider business mailing address

11126 CORONA AVE
FLUSHING NY
11368-4027
US

V. Phone/Fax

Practice location:
  • Phone: 718-592-6400
  • Fax: 718-592-1400
Mailing address:
  • Phone: 718-592-6400
  • Fax: 718-592-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number7003392N
License Number StateNY

VIII. Authorized Official

Name: MR. HERBERT TUCHMAN
Title or Position: PRESIDENT
Credential:
Phone: 718-592-6400