Provider Demographics
NPI:1487669172
Name:ISLAND REHABILITATION AND NURSING CENTER INC.
Entity Type:Organization
Organization Name:ISLAND REHABILITATION AND NURSING CENTER INC.
Other - Org Name:ISLAND NURSING AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-758-3336
Mailing Address - Street 1:5537 EXPRESSWAY DR N
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1316
Mailing Address - Country:US
Mailing Address - Phone:631-758-3336
Mailing Address - Fax:631-930-7413
Practice Address - Street 1:5537 EXPRESSWAY DR N
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1316
Practice Address - Country:US
Practice Address - Phone:631-758-3336
Practice Address - Fax:631-930-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5151318N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02228191Medicaid
NY335835Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER