Healthcare Provider Details

I. General information

NPI: 1427365915
Provider Name (Legal Business Name): JEWISH COMMUNITY CENTER OF STATEN ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 MANOR RD
STATEN ISLAND NY
10314-7027
US

IV. Provider business mailing address

1466 MANOR RD
STATEN ISLAND NY
10314-7027
US

V. Phone/Fax

Practice location:
  • Phone: 718-475-5240
  • Fax: 718-475-5206
Mailing address:
  • Phone: 718-475-5240
  • Fax: 718-475-5206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LEE GUTTENPLAN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 718-475-5240