Provider Demographics
NPI:1073708376
Name:KINGSBROOK JEWISH MEDICAL CENTER
Entity Type:Organization
Organization Name:KINGSBROOK JEWISH MEDICAL CENTER
Other - Org Name:RUTLAND NURSING HOME ADULT DAY HEALTH CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SVPF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-604-5000
Mailing Address - Street 1:585 SCHENECTADY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1851
Mailing Address - Country:US
Mailing Address - Phone:718-604-5000
Mailing Address - Fax:718-604-5527
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1851
Practice Address - Country:US
Practice Address - Phone:718-604-5532
Practice Address - Fax:718-604-5527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTLAND NURSING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001033N261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01221952Medicaid