Basic Information
| Provider Information | |||||||||
| NPI: | 1811986359 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW EAST SIDE NURSING HOME LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 BIALYSTOKER PL | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100024008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126738500 | ||||||||
| FaxNumber: | 6466021684 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 BIALYSTOKER PL | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100024008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126738500 | ||||||||
| FaxNumber: | 6466021684 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MASTROPIERRO | ||||||||
| AuthorizedOfficialFirstName: | CORRADO | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2126738500 | ||||||||
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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 | 00310027 | 05 | NY | MEDICAID |