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NPI Code Detail

MEDICARE: PORT CHESTER OPERATING LLC

MEDICARE: PORT CHESTER OPERATING 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
1314000000XSkilled Nursing Facility5906304NNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1335312OTHERNYMRE PROVIDER #

General Provider Information

NPI Number : 1154774271
Entity Type Code : Organization
Provider Name (Legal Business Name) : PORT CHESTER OPERATING LLC
Provider Business Mailing Address
First Line : 1000 HIGH ST
Second Line :
City : PORT CHESTER
State : NY
Zip : 10573-4402
Country : US
Telephone Number : 201-731-1700
Fax Number :
Provider Business Practice Location Address
First Line : 1000 HIGH ST
Second Line :
City : PORT CHESTER
State : NY
Zip : 10573-4402
Country : US
Telephone Number : 201-731-1700
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MARK FRIEDMAN
Credential :
Telephone Number : 201-731-1700
Provider Enumeration Date : 07/14/2016
Last Update Date : 03/31/2017

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Directions to “PORT CHESTER OPERATING LLC ” Practice Location

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