Provider Demographics
NPI:1013006139
Name:MICHAEL N. MALOTZ SKILLED NURSING PAVILION
Entity Type:Organization
Organization Name:MICHAEL N. MALOTZ SKILLED NURSING PAVILION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-964-3333
Mailing Address - Street 1:120 ODELL AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1301
Mailing Address - Country:US
Mailing Address - Phone:914-964-3333
Mailing Address - Fax:914-964-4726
Practice Address - Street 1:120 ODELL AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1408
Practice Address - Country:US
Practice Address - Phone:914-964-3333
Practice Address - Fax:914-964-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5907316N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02171933Medicaid
NY023855OtherEMPIRE BLUE CROSS BLUE SH
NY023855OtherEMPIRE BLUE CROSS BLUE SH