Healthcare Provider Details

I. General information

NPI: 1356730642
Provider Name (Legal Business Name): MT VERNON ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 8TH AVE STE 1402
NEW YORK NY
10018-6505
US

IV. Provider business mailing address

22 E 1ST ST
MOUNT VERNON NY
10550-3301
US

V. Phone/Fax

Practice location:
  • Phone: 646-416-6669
  • Fax: 888-371-3078
Mailing address:
  • Phone: 917-474-7967
  • Fax: 888-371-3078

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: MR. MARVIN BEINHORN
Title or Position: PRESIDENT
Credential:
Phone: 917-474-7967