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NPI Code Detail

MEDICARE: NEW BROADVIEW MANOR HFA, LLC

MEDICARE: NEW BROADVIEW MANOR HFA, 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 062NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104041029
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW BROADVIEW MANOR HFA, LLC
Provider Business Mailing Address
First Line : 70 FATHER CAPODANNO BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-4803
Country : US
Telephone Number : 718-273-8900
Fax Number : 718-720-2415
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 : 718-273-8900
Fax Number : 718-720-2415
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. LUDOVIC MARCOVICI
Credential :
Telephone Number : 718-273-8900
Provider Enumeration Date : 04/16/2007
Last Update Date : 05/07/2012

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