Provider Demographics
NPI:1477541084
Name:STONEHEDGE AQUISITION CHITTENANGO I, LLC
Entity Type:Organization
Organization Name:STONEHEDGE AQUISITION CHITTENANGO I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUPNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-357-7666
Mailing Address - Street 1:386 RT 59
Mailing Address - Street 2:SUITE 409
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952
Mailing Address - Country:US
Mailing Address - Phone:845-357-7666
Mailing Address - Fax:845-357-0727
Practice Address - Street 1:331 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-1201
Practice Address - Country:US
Practice Address - Phone:315-687-7255
Practice Address - Fax:315-687-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2629302N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00356354Medicaid
NY335588Medicare ID - Type Unspecified