Healthcare Provider Details

I. General information

NPI: 1821469941
Provider Name (Legal Business Name): DRY HARBOR HRF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 DRY HARBOR RD SUITE 284
MIDDLE VILLAGE NY
11379-1528
US

IV. Provider business mailing address

6135 DRY HARBOR RD
MIDDLE VILLAGE NY
11379-1528
US

V. Phone/Fax

Practice location:
  • Phone: 718-565-4200
  • Fax: 718-505-7850
Mailing address:
  • Phone: 718-565-4200
  • Fax: 718-505-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7003359N
License Number StateNY

VIII. Authorized Official

Name: MAYER GUTMAN
Title or Position: CFO
Credential:
Phone: 718-565-4200