Healthcare Provider Details

I. General information

NPI: 1356339824
Provider Name (Legal Business Name): THE NEW MIDWAY CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6995 QUEENS MIDTOWN EXPY
MASPETH NY
11378-1922
US

IV. Provider business mailing address

6995 QUEENS MIDTOWN EXPY
MASPETH NY
11378-1922
US

V. Phone/Fax

Practice location:
  • Phone: 718-429-2200
  • Fax: 718-898-7582
Mailing address:
  • Phone: 718-429-2200
  • Fax: 718-898-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7003340N
License Number StateNY

VIII. Authorized Official

Name: MR. MARTIN FREDERICK CZIRALCY
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 718-429-2200