Healthcare Provider Details

I. General information

NPI: 1275048035
Provider Name (Legal Business Name): OM ADULT DAY CARE CENTER OF NY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13005 101ST AVE
SOUTH RICHMOND HILL NY
11419-1519
US

IV. Provider business mailing address

13005 101ST AVE
SOUTH RICHMOND HILL NY
11419-1519
US

V. Phone/Fax

Practice location:
  • Phone: 347-537-5995
  • Fax:
Mailing address:
  • Phone: 347-537-5995
  • Fax:

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: HEMANG PATEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 732-766-5899