Healthcare Provider Details

I. General information

NPI: 1073851499
Provider Name (Legal Business Name): FIFTH AVENUE SADC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 5TH AVE
NEW YORK NY
10029-2660
US

IV. Provider business mailing address

1325 5TH AVE
NEW YORK NY
10029-2660
US

V. Phone/Fax

Practice location:
  • Phone: 212-831-6100
  • Fax:
Mailing address:
  • Phone: 212-831-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANNA SHTEYNBERG
Title or Position: PRESIDENT
Credential:
Phone: 646-255-7929