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General NPI Number Information
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NPI Number | 1487676649
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND CARE CENTER
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 LAFAYETTE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301-1219
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Country | US
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Telephone | 718-448-9000
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Fax | 718-727-2712
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Provider Business Mailing Address
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Address Line | 200 LAFAYETTE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10301-1219
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Country | US
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Telephone | 718-448-9000
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Fax | 718-727-2712
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MATIS WEINSTOCK
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Credential | LNHA
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Telephone | 718-448-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 02479
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License Number State | NY
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