Provider Demographics
NPI:1225029234
Name:FULTON COMMONS CARE CENTER, INC.
Entity Type:Organization
Organization Name:FULTON COMMONS CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-961-1212
Mailing Address - Street 1:14310 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3046
Mailing Address - Country:US
Mailing Address - Phone:718-961-1212
Mailing Address - Fax:718-939-5467
Practice Address - Street 1:60 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1578
Practice Address - Country:US
Practice Address - Phone:516-222-9300
Practice Address - Fax:516-222-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2950317N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02204108Medicaid
NY02204108Medicaid