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General NPI Number Information
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NPI Number | 1629250378
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Entity Type | Organization
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Legal Business Name | LOTT ASSISTED LIVING RESIDENCE
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 1261 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10029-3822
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Country | US
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Telephone | 212-534-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 1261 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10029-3822
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Country | US
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Telephone | 212-534-6464
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & C.E.O.
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Name | MR. JAMES F. JANESKI
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Credential |
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Telephone | 12125346464
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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 | 420S378
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License Number State | NY
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