Provider Demographics
NPI:1013001197
Name:HOSPICE OF NEW YORK, LLC
Entity Type:Organization
Organization Name:HOSPICE OF NEW YORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-472-1999
Mailing Address - Street 1:4518 COURT SQ STE 500
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4347
Mailing Address - Country:US
Mailing Address - Phone:718-472-1999
Mailing Address - Fax:718-472-5222
Practice Address - Street 1:4518 COURT SQ STE 500
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4347
Practice Address - Country:US
Practice Address - Phone:718-472-1999
Practice Address - Fax:718-472-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003501F251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01792052Medicaid
NYA769951OtherOXFORD HP PROVIDER #
NY017441OtherBLUE CROSS PROVIDER #
NY01792052Medicaid