Healthcare Provider Details

I. General information

NPI: 1487676649
Provider Name (Legal Business Name): STATEN ISLAND CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 08/22/2020
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: 718-727-2712
Mailing address:
  • Phone: 718-448-9000
  • Fax: 718-727-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number02479
License Number StateNY

VIII. Authorized Official

Name: MR. MATIS WEINSTOCK
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 718-448-9000