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NPI Code Detail

MEDICARE: PROSPECT PARK OPERATING, LLC

MEDICARE: PROSPECT PARK OPERATING, 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
1314000000XSkilled Nursing Facility7001388NNY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841365509
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROSPECT PARK OPERATING, LLC
Provider Business Mailing Address
First Line : 4770 WHITE PLAINS RD
Second Line :
City : BRONX
State : NY
Zip : 10470-1104
Country : US
Telephone Number : 718-931-9700
Fax Number :
Provider Business Practice Location Address
First Line : 170 BUFFALO AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11213-2421
Country : US
Telephone Number : 718-252-9800
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : MR. KENNETH ROZENBERG
Credential :
Telephone Number : 917-468-4174
Provider Enumeration Date : 11/21/2006
Last Update Date : 08/21/2020

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Directions to “PROSPECT PARK OPERATING, LLC ” Practice Location

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