Healthcare Provider Details

I. General information

NPI: 1720592280
Provider Name (Legal Business Name): ORCHID ADULT DAYCARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BROAD ST
TONAWANDA NY
14150-2110
US

IV. Provider business mailing address

199 LEE AVE # 925
BROOKLYN NY
11211-8919
US

V. Phone/Fax

Practice location:
  • Phone: 716-514-8060
  • Fax:
Mailing address:
  • Phone:
  • 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: DAVID NEUSTEIN
Title or Position: PRESIDENT
Credential:
Phone: 347-432-9566