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NPI Code Detail

MEDICARE: MONTGOMERY NURSING HOME

MEDICARE: MONTGOMERY NURSING HOME
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 Facility3560301NNY

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 : 1972669364
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONTGOMERY NURSING HOME
Provider Business Mailing Address
First Line : 2817 ALBANY POST RD
Second Line :
City : MONTGOMERY
State : NY
Zip : 12549-2132
Country : US
Telephone Number : 845-457-3155
Fax Number :
Provider Business Practice Location Address
First Line : 2817 ALBANY POST RD
Second Line :
City : MONTGOMERY
State : NY
Zip : 12549-2132
Country : US
Telephone Number : 845-457-3155
Fax Number :
Authorized Official
Title or Position : PARTNER
Name : DR. JEREMY R MACK
Credential :
Telephone Number : 845-457-3155
Provider Enumeration Date : 12/29/2006
Last Update Date : 08/22/2020

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Directions to “MONTGOMERY NURSING HOME ” Practice Location

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