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NPI Code Detail

MEDICARE: THE W GROUP AT NEW BROADVIEW, LLC

MEDICARE: THE W GROUP AT NEW BROADVIEW, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility610-F-067NY
2251E00000XHome Health Agency2670L001NY
3311ZA0620XAdult Care Home Facility610-F-067NY

General Provider Information

NPI Number : 1033611736
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE W GROUP AT NEW BROADVIEW, LLC
Provider Business Mailing Address
First Line : 2357 60TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11204-2689
Country : US
Telephone Number : 718-840-3355
Fax Number : 347-436-8045
Provider Business Practice Location Address
First Line : 70 FATHER CAPODANNO BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-4803
Country : US
Telephone Number : 718-840-3355
Fax Number : 347-436-8045
Authorized Official
Title or Position : PROJECT MANAGER
Name : MRS. JENNIFER GRAJALES
Credential :
Telephone Number : 718-840-3355
Provider Enumeration Date : 03/08/2018
Last Update Date : 10/15/2020

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