Healthcare Provider Details

I. General information

NPI: 1356434781
Provider Name (Legal Business Name): JEWISH HOME LIFECARE, MANHATTAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 106TH ST
NEW YORK NY
10025-3923
US

IV. Provider business mailing address

120 W 106TH ST
NEW YORK NY
10025-3923
US

V. Phone/Fax

Practice location:
  • Phone: 212-870-4972
  • Fax: 212-870-4982
Mailing address:
  • Phone: 212-870-4972
  • Fax: 212-870-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number011111
License Number StateNY

VIII. Authorized Official

Name: RENEE HOFMAN
Title or Position: SENIOR DIRECTOR OF PHARMACY
Credential: MS, RPH
Phone: 718-410-1289