Healthcare Provider Details

I. General information

NPI: 1396731279
Provider Name (Legal Business Name): MONSIGNOR FITZPATRICK SN PAVILION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 89TH AVE
JAMAICA NY
11432-3730
US

IV. Provider business mailing address

15211 89TH AVE
JAMAICA NY
11432-3730
US

V. Phone/Fax

Practice location:
  • Phone: 718-558-2870
  • Fax: 718-558-2476
Mailing address:
  • Phone: 718-558-2870
  • Fax: 718-558-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MELVIN AARON
Title or Position: ADMINISTRATOR
Credential:
Phone: 718-558-2870