MEDICARE: GREENPARK CARE 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	332BN1400X	Nursing Facility Supplies (DME)	1075730001	NY
2	332B00000X	Durable Medical Equipment & Medical Supplies	1075730001	NY

General Provider Information

NPI Number	:	1295909158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENPARK CARE CENTER INC

Provider Business Mailing Address
First Line	:	140 SAINT EDWARDS ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3904
Country	:	US
Telephone Number	:	718-855-6789
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 SAINT EDWARDS ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-3904
Country	:	US
Telephone Number	:	718-855-6789
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MR. THOMAS QUINN
Credential	:
Telephone Number	:	718-858-6400

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	08/01/2008

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