Basic Information
| Provider Information | |||||||||
| NPI: | 1639245590 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BIALYSTOKER CENTER FOR NURSING & REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 228 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100025601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124757755 | ||||||||
| FaxNumber: | 2127778594 | ||||||||
| Practice Location | |||||||||
| Address1: | 228 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100025601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124757755 | ||||||||
| FaxNumber: | 2127778594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | TAUB | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2124757755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 7002308N | 05 | NY | MEDICAID | 00311284 | 05 | NY | MEDICAID |