MEDICARE: ISABELLA GERIATRIC CENTER, INC.

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
1	251E00000X	Home Health Agency	7002905L	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1144245978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISABELLA GERIATRIC CENTER, INC.

Provider Business Mailing Address
First Line	:	515 AUDUBON AVE
Second Line	:	ATTN: FINANCE
City	:	NEW YORK
State	:	NY
Zip	:	10040-3403
Country	:	US
Telephone Number	:	212-342-9309
Fax Number	:	212-781-6303

Provider Business Practice Location Address
First Line	:	5073 BROADWAY
Second Line	:	ATTN: HOME CARE
City	:	NEW YORK
State	:	NY
Zip	:	10034-1131
Country	:	US
Telephone Number	:	212-342-9500
Fax Number	:	212-342-9876

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	MR. MARK J KATOR
Credential	:
Telephone Number	:	212-342-9300

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	02/10/2009

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