MEDICARE: BROOKLYN QUEENS 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	7001382N	NY

General Provider Information

NPI Number	:	1871582825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN QUEENS NURSING HOME, INC

Provider Business Mailing Address
First Line	:	2749 LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-5110
Country	:	US
Telephone Number	:	718-277-5100
Fax Number	:	718-647-2597

Provider Business Practice Location Address
First Line	:	2749 LINDEN BLVD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-5110
Country	:	US
Telephone Number	:	718-277-5100
Fax Number	:	718-647-2597

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MARTY DICKER
Credential	:
Telephone Number	:	718-277-5100

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	11/02/2016

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