Healthcare Provider Details

I. General information

NPI: 1770130825
Provider Name (Legal Business Name): BERWICK PA OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 16TH ST
BERWICK PA
18603-2314
US

IV. Provider business mailing address

1449 37TH ST STE 605
BROOKLYN NY
11218-4380
US

V. Phone/Fax

Practice location:
  • Phone: 212-444-1991
  • Fax:
Mailing address:
  • Phone: 646-649-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ISAAC MOSKOWITZ
Title or Position: CEO
Credential:
Phone: 212-390-1054