Healthcare Provider Details

I. General information

NPI: 1235138165
Provider Name (Legal Business Name): PALJR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 GREAT EAST NECK RD
WEST BABYLON NY
11704-8027
US

IV. Provider business mailing address

134 GREAT EAST NECK RD
WEST BABYLON NY
11704-8027
US

V. Phone/Fax

Practice location:
  • Phone: 631-422-4800
  • Fax: 631-422-1371
Mailing address:
  • Phone: 631-422-4800
  • Fax: 631-422-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5150303N
License Number StateNY

VIII. Authorized Official

Name: MR. ALEX SOLOVEY
Title or Position: MANAGING MEMBER
Credential:
Phone: 631-422-4800