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General NPI Number Information
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NPI Number | 1063454494
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Entity Type | Organization
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Legal Business Name | IRVINGTON HEALTHCARE PROVIDERS LLC
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 155 40TH ST
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City | IRVINGTON
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State | NJ
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Zip | 07111-1184
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Country | US
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Telephone | 973-371-7878
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Fax | 973-371-4081
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Provider Business Mailing Address
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Address Line | 170 53RD ST 3RD FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11232-4319
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Country | US
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Telephone | 718-567-0400
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Fax | 718-567-0600
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Authorized Official
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Title or Position | COMPTROLLER
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Name | MR. SAM STERN
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Credential |
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Telephone | 718-576-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 060736
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License Number State | NJ
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