Healthcare Provider Details

I. General information

NPI: 1235187964
Provider Name (Legal Business Name): NESCONSET NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTHERN BLVD.
NESCONSET NY
11767-1797
US

IV. Provider business mailing address

100 SOUTHERN BLVD.
NESCONSET NY
11767-1797
US

V. Phone/Fax

Practice location:
  • Phone: 631-361-8800
  • Fax: 631-361-9528
Mailing address:
  • Phone: 631-361-8800
  • Fax: 631-361-9528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RONALD RANIERI
Title or Position: ADMINISTRATOR
Credential:
Phone: 631-361-8800