Healthcare Provider Details

I. General information

NPI: 1609879915
Provider Name (Legal Business Name): NORTHERN MANHATTAN NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E 125TH ST
NEW YORK NY
10035-1612
US

IV. Provider business mailing address

116 E 125TH ST
NEW YORK NY
10035-1612
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-1284
  • Fax: 212-427-9509
Mailing address:
  • Phone: 212-426-1284
  • Fax: 212-427-9509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7002355
License Number StateNY

VIII. Authorized Official

Name: MR. MARTY LOEB
Title or Position: CONTROLLER
Credential:
Phone: 212-426-1284