Healthcare Provider Details

I. General information

NPI: 1447248273
Provider Name (Legal Business Name): STATEN ISLAND CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LAFAYETTE AVE
STATEN ISLAND NY
10301-1219
US

IV. Provider business mailing address

200 LAFAYETTE AVE
STATEN ISLAND NY
10301-1219
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-9000
  • Fax: 718-448-9184
Mailing address:
  • Phone: 718-448-9000
  • Fax: 718-448-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7004314N
License Number StateNY

VIII. Authorized Official

Name: MS. SHANNON M BARBACK
Title or Position: MEDICAL RECORDS
Credential:
Phone: 718-448-9000