Provider Demographics
NPI:1023568185
Name:PARKSHORE HEALTHCARE LLC
Entity Type:Organization
Organization Name:PARKSHORE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-927-6346
Mailing Address - Street 1:1535 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4001
Mailing Address - Country:US
Mailing Address - Phone:718-927-6346
Mailing Address - Fax:718-272-2166
Practice Address - Street 1:1535 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4001
Practice Address - Country:US
Practice Address - Phone:718-927-6346
Practice Address - Fax:718-272-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001641251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995779Medicaid
NY7001641OtherSTATE OPERATING CERTF. #
NY7001641OtherSTATE OPERATING CERTF. #