Provider Demographics
NPI:1568655645
Name:BORIS MENDEL
Entity Type:Organization
Organization Name:BORIS MENDEL
Other - Org Name:NEW CENTRAL MANOR ALP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-471-7700
Mailing Address - Street 1:1509 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4001
Mailing Address - Country:US
Mailing Address - Phone:718-471-7700
Mailing Address - Fax:
Practice Address - Street 1:1509 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4001
Practice Address - Country:US
Practice Address - Phone:718-471-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY590-F-148310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01447396Medicaid