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General NPI Number Information
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NPI Number | 1104041029
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Entity Type | Organization
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Legal Business Name | NEW BROADVIEW MANOR HFA, LLC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 70 FATHER CAPODANNO BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4803
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Country | US
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Telephone | 718-273-8900
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Fax | 718-720-2415
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Provider Business Mailing Address
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Address Line | 70 FATHER CAPODANNO BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10305-4803
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Country | US
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Telephone | 718-273-8900
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Fax | 718-720-2415
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. LUDOVIC MARCOVICI
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Credential |
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Telephone | 718-273-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 610 F 062
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License Number State | NY
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