Basic Information
| Provider Information | |||||||||
| NPI: | 1235276981 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELANT AT FISHKILL INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ELANT AT WAPPINGER FALLS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 46 HARRIMAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109242410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453601200 | ||||||||
| FaxNumber: | 8452913833 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 S MESIER AVENUE | ||||||||
| Address2: | |||||||||
| City: | WAPPINGER FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125902718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453601200 | ||||||||
| FaxNumber: | 8452913833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 05/04/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WHITNEY | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8453601361 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ELANT AT FISHKILL INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1324301N | NY | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 314000000X | 1324302N | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.