Healthcare Provider Details

I. General information

NPI: 1033145735
Provider Name (Legal Business Name): DE WITT REHAB AND NURSING HOME PHCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E 79TH ST
NEW YORK NY
10021-0819
US

IV. Provider business mailing address

211 E 79TH ST
NEW YORK NY
10021-0819
US

V. Phone/Fax

Practice location:
  • Phone: 212-879-1600
  • Fax: 212-879-4594
Mailing address:
  • Phone: 212-879-1600
  • Fax: 212-879-4594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number025580
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EDWARD AHRENS
Title or Position: SUPERVISING PHARMACIST
Credential: R.PH
Phone: 212-879-1600