Basic Information
| Provider Information | |||||||||
| NPI: | 1003364662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH MET OPERATIONS ASSOC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4770 WHITE PLAINS RD | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104701104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189319700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 MAPLE AVENUE | ||||||||
| Address2: | |||||||||
| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109522715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453529000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2016 | ||||||||
| LastUpdateDate: | 09/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | ROZENBERG | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7189319700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | 4353301N | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
ID Information
| ID | Type | State | Issuer | Description | 00577720 | 05 | NY | MEDICAID |