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General NPI Number Information
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NPI Number | 1124461256
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Entity Type | Organization
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Legal Business Name | SILVER AGE CARE, INC
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 14 BRUCKNER BLVD
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City | BRONX
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State | NY
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Zip | 10454-4414
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Country | US
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Telephone | 718-414-2427
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Fax |
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Provider Business Mailing Address
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Address Line | 14 BRUCKNER BLVD
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City | BRONX
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State | NY
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Zip | 10454-4414
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Country | US
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Telephone | 718-414-2427
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEXANDER YUSUPOV
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Credential |
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Telephone | 212-581-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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