Healthcare Provider Details

I. General information

NPI: 1396003182
Provider Name (Legal Business Name): SV OPERATING THREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 TOMPKINS AVE
STATEN ISLAND NY
10304-2601
US

IV. Provider business mailing address

4770 WHITE PLAINS RD
BRONX NY
10470-1104
US

V. Phone/Fax

Practice location:
  • Phone: 718-931-9700
  • Fax:
Mailing address:
  • Phone: 718-931-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH ROZENBERG
Title or Position: MEMBER
Credential:
Phone: 718-931-9700