Healthcare Provider Details

I. General information

NPI: 1043037591
Provider Name (Legal Business Name): ULTIMATE ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 AMBOY RD
STATEN ISLAND NY
10308-2409
US

IV. Provider business mailing address

4024 AMBOY RD
STATEN ISLAND NY
10308-2409
US

V. Phone/Fax

Practice location:
  • Phone: 718-605-0888
  • Fax:
Mailing address:
  • Phone: 718-605-0888
  • 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: TING QIAN LIN
Title or Position: PRESIDENT
Credential:
Phone: 718-605-0888