MEDICARE: HYDE PARK NURSING HOME, 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	314000000X	Skilled Nursing Facility	1356302N	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	:	1467471375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYDE PARK NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	4975 ALBANY POST ROAD
Second Line	:
City	:	STAATSBURG
State	:	NY
Zip	:	12580
Country	:	US
Telephone Number	:	845-889-4500
Fax Number	:	845-889-4309

Provider Business Practice Location Address
First Line	:	4975 ALBANY POST ROAD
Second Line	:
City	:	STAATSBURG
State	:	NY
Zip	:	12580
Country	:	US
Telephone Number	:	845-889-4500
Fax Number	:	845-889-4309

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. RAPHAEL YENOWITZ
Credential	:
Telephone Number	:	845-889-4500

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/17/2016

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