Healthcare Provider Details

I. General information

NPI: 1326298209
Provider Name (Legal Business Name): WARTBURG RECEIVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17261 BAISLEY BLVD
JAMAICA NY
11434-2614
US

IV. Provider business mailing address

4770 WHITE PLAINS RD
BRONX NY
10470
US

V. Phone/Fax

Practice location:
  • Phone: 718-525-2997
  • Fax:
Mailing address:
  • Phone: 718-931-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number7001364N
License Number StateNY

VIII. Authorized Official

Name: MR. KENNETH ROZENBERG
Title or Position: MEMBER
Credential:
Phone: 718-931-9700