Basic Information
| Provider Information | |||||||||
| NPI: | 1184799587 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION | ||||||||
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| OtherOrganizationName: | CERTIFIED HOME HEALTH CARE AGENCY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27111 76TH AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110401436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182892100 | ||||||||
| FaxNumber: | 7182892323 | ||||||||
| Practice Location | |||||||||
| Address1: | 27111 76TH AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110401436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182892100 | ||||||||
| FaxNumber: | 7182892323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 08/30/2017 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WERNER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP OPERATIONS/CFO | ||||||||
| AuthorizedOfficialTelephone: | 7182892354 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 7003902L | NY | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 00912065 | 05 | NY | MEDICAID |