Healthcare Provider Details

I. General information

NPI: 1750895942
Provider Name (Legal Business Name): UTICA OPERATIONS ASSOC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 KEMBLE ST
UTICA NY
13501-4441
US

IV. Provider business mailing address

4770 WHITE PLAINS RD
BRONX NY
10470-1104
US

V. Phone/Fax

Practice location:
  • Phone: 315-732-0100
  • Fax: 315-732-2342
Mailing address:
  • Phone: 718-931-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01640904
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

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