Healthcare Provider Details

I. General information

NPI: 1174520704
Provider Name (Legal Business Name): GLENGARIFF CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 DOSORIS LN
GLEN COVE NY
11542-1225
US

IV. Provider business mailing address

141 DOSORIS LN
GLEN COVE NY
11542-1225
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-1100
  • Fax: 516-759-0267
Mailing address:
  • Phone: 516-676-1100
  • Fax: 516-759-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2901300N
License Number StateNY

VIII. Authorized Official

Name: MR. SANJAY AHUJA
Title or Position: PRESIDENT
Credential:
Phone: 516-676-1100