Healthcare Provider Details

I. General information

NPI: 1831584796
Provider Name (Legal Business Name): SHALOM SADC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SHORE RD
GREAT NECK NY
11024-2140
US

IV. Provider business mailing address

400 E SHORE RD
GREAT NECK NY
11024-2140
US

V. Phone/Fax

Practice location:
  • Phone: 516-603-9770
  • Fax: 516-482-2530
Mailing address:
  • Phone: 516-603-9770
  • Fax: 516-482-2530

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. JOSEPH GEISINSKY
Title or Position: PRESIDENT
Credential:
Phone: 516-603-9770