Healthcare Provider Details

I. General information

NPI: 1336136217
Provider Name (Legal Business Name): WOODBURY CENTER FOR HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8533 JERICHO TPKE
WOODBURY NY
11797-1804
US

IV. Provider business mailing address

8533 JERICHO TPKE
WOODBURY NY
11797-1804
US

V. Phone/Fax

Practice location:
  • Phone: 516-692-4100
  • Fax: 516-692-7571
Mailing address:
  • Phone: 516-692-4100
  • Fax: 516-692-7571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2952303N
License Number StateNY

VIII. Authorized Official

Name: MR. FREDERICK E. WHITE
Title or Position: ADMINISTRATOR
Credential:
Phone: 516-692-4100