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General NPI Number Information
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NPI Number | 1326298209
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Entity Type | Organization
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Legal Business Name | WARTBURG RECEIVER LLC
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 06/12/2017
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Provider Practice Location Address
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Address Line | 17261 BAISLEY BLVD
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City | JAMAICA
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State | NY
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Zip | 11434-2614
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Country | US
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Telephone | 718-525-2997
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Fax |
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Provider Business Mailing Address
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Address Line | 4770 WHITE PLAINS RD
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City | BRONX
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State | NY
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Zip | 10470
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Country | US
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Telephone | 718-931-9700
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. KENNETH ROZENBERG
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Credential |
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Telephone | 718-931-9700
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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 | 7001364N
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License Number State | NY
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