Basic Information
| Provider Information | |||||||||
| NPI: | 1184614398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN METROPOLITAN INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109522715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453529000 | ||||||||
| FaxNumber: | 8453529082 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109522715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453529000 | ||||||||
| FaxNumber: | 8453529082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | KLEIN | ||||||||
| AuthorizedOfficialFirstName: | GEDALIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8453529000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LNHA | ||||||||
| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | 314000000X | 4353301N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 02994512 | 05 | NY | MEDICAID |