Healthcare Provider Details

I. General information

NPI: 1831155100
Provider Name (Legal Business Name): WLOP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MAIN STREET
PEEKSKILL NY
10566-2502
US

IV. Provider business mailing address

2000 MAIN STREET
PEEKSKILL NY
10566-2502
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-8400
  • Fax:
Mailing address:
  • Phone: 914-737-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5901305N
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00318007
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MR. NATHAN STERN
Title or Position: AUT MEMBER
Credential:
Phone: 732-942-1344