Provider Demographics
NPI:1033145735
Name:DE WITT REHAB AND NURSING HOME PHCY
Entity Type:Organization
Organization Name:DE WITT REHAB AND NURSING HOME PHCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-879-1600
Mailing Address - Street 1:211 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0819
Mailing Address - Country:US
Mailing Address - Phone:212-879-1600
Mailing Address - Fax:212-879-4594
Practice Address - Street 1:211 E 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0819
Practice Address - Country:US
Practice Address - Phone:212-879-1600
Practice Address - Fax:212-879-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025580333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3337979OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY00310421Medicaid
3337979Medicare ID - Type Unspecified