Healthcare Provider Details

I. General information

NPI: 1144393869
Provider Name (Legal Business Name): THE JEWISH HOME & HOSPITAL FOR AGED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 5TH AVE 7TH FLOOR
NEW YORK NY
10018-2797
US

IV. Provider business mailing address

404 5TH AVE 7TH FLOOR
NEW YORK NY
10018-2797
US

V. Phone/Fax

Practice location:
  • Phone: 212-273-2564
  • Fax:
Mailing address:
  • Phone: 212-273-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number7002340N
License Number StateNY

VIII. Authorized Official

Name: AUDREY WEINER
Title or Position: CEO
Credential: DSW
Phone: 212-870-4600