MEDICARE: MARGARET TIETZ NURSING AND REHABILITATION CENTER

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	7003305N	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	:	1730182254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARGARET TIETZ NURSING AND REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	1250 WATERS PLACE
Second Line	:	TOWER 1, SUITE 602
City	:	BRONX
State	:	NY
Zip	:	10461-2731
Country	:	US
Telephone Number	:	718-239-1405
Fax Number	:	347-640-6009

Provider Business Practice Location Address
First Line	:	164-11 CHAPIN PKWY
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432
Country	:	US
Telephone Number	:	718-298-7800
Fax Number	:	718-262-8839

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	MR. JOHN KEHOE
Credential	:
Telephone Number	:	718-239-1405

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	01/13/2017

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