Healthcare Provider Details

I. General information

NPI: 1750076956
Provider Name (Legal Business Name): MOLINA SOCIAL ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 73RD ST STE 301
JACKSON HEIGHTS NY
11372-6218
US

IV. Provider business mailing address

3718 73RD ST STE 301
JACKSON HEIGHTS NY
11372-6218
US

V. Phone/Fax

Practice location:
  • Phone: 201-982-3120
  • Fax: 201-489-8035
Mailing address:
  • Phone: 201-982-3120
  • Fax: 201-489-8035

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: DR. GAJENDRA PATEL
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 201-982-3120