Provider Demographics
NPI:1326457714
Name:NISKAYUNA OPERATING COMPANY, LLD
Entity Type:Organization
Organization Name:NISKAYUNA OPERATING COMPANY, LLD
Other - Org Name:PATHWAYS NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:GAYLORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-374-2212
Mailing Address - Street 1:1805 PROVIDENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309
Mailing Address - Country:US
Mailing Address - Phone:518-374-2212
Mailing Address - Fax:518-374-4330
Practice Address - Street 1:1805 PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-3923
Practice Address - Country:US
Practice Address - Phone:518-374-2212
Practice Address - Fax:518-374-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4662302N3140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1356657423Medicare Oscar/Certification