Provider Demographics
NPI:1487676649
Name:STATEN ISLAND CARE CENTER
Entity Type:Organization
Organization Name:STATEN ISLAND CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:718-448-9000
Mailing Address - Street 1:200 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1219
Mailing Address - Country:US
Mailing Address - Phone:718-448-9000
Mailing Address - Fax:718-727-2712
Practice Address - Street 1:200 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1219
Practice Address - Country:US
Practice Address - Phone:718-448-9000
Practice Address - Fax:718-727-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02479376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314690Medicaid