Provider Demographics
NPI:1407901119
Name:NEW CARLTON REHABILITATION & NURSING CENTER
Entity Type:Organization
Organization Name:NEW CARLTON REHABILITATION & NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-789-6262
Mailing Address - Street 1:405 CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1510
Mailing Address - Country:US
Mailing Address - Phone:718-789-6262
Mailing Address - Fax:718-789-2200
Practice Address - Street 1:405 CARLTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1510
Practice Address - Country:US
Practice Address - Phone:718-789-6262
Practice Address - Fax:718-789-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001386N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02394874Medicaid
NY335131Medicare ID - Type Unspecified