MEDICARE: PARKSHORE HEALTH CARE 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
1	261QA0600X	Adult Day Care Clinic/Center	7001385N	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568695450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKSHORE HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	1555 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4001
Country	:	US
Telephone Number	:	718-927-6346
Fax Number	:	718-272-2166

Provider Business Practice Location Address
First Line	:	1555 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4001
Country	:	US
Telephone Number	:	718-927-6346
Fax Number	:	718-272-2166

Authorized Official
Title or Position	:	CEO
Name	:	BARRY FRIEDMAN
Credential	:
Telephone Number	:	718-927-6300

Provider Enumeration Date	:	08/26/2009
Last Update Date	:	04/19/2010

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Directions to “PARKSHORE HEALTH CARE LLC ” Practice Location

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