MEDICARE: OAK HOLLOW NC CORP.

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	314000000X	Skilled Nursing Facility	5151315N	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	:	1194718262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK HOLLOW NC CORP.

Provider Business Mailing Address
First Line	:	49 OAKCREST AVE
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-1415
Country	:	US
Telephone Number	:	631-924-8820
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 OAKCREST AVE
Second Line	:
City	:	MIDDLE ISLAND
State	:	NY
Zip	:	11953-1415
Country	:	US
Telephone Number	:	631-924-8820
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACOB DIMANT
Credential	:	M.D.
Telephone Number	:	212-572-0920

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/07/2008

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