Provider Demographics
NPI:1407054158
Name:MADISON YORK REGO PARK LLC DBA MADISON YORK ALP
Entity Type:Organization
Organization Name:MADISON YORK REGO PARK LLC DBA MADISON YORK ALP
Other - Org Name:TIBOR KLEIN DBA MADISON YORK ALP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIBOR
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-446-7900
Mailing Address - Street 1:61-80 WOODHAVEN BLVD.
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2742
Mailing Address - Country:US
Mailing Address - Phone:718-446-4300
Mailing Address - Fax:718-899-8126
Practice Address - Street 1:61-80 WOODHAVEN BLVD.
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2742
Practice Address - Country:US
Practice Address - Phone:718-446-4300
Practice Address - Fax:718-899-8126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-04
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY590-F-195310400000X
NY590 F 320310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01448264Medicaid