Provider Demographics
NPI:1609879915
Name:NORTHERN MANHATTAN NURSING HOME INC
Entity Type:Organization
Organization Name:NORTHERN MANHATTAN NURSING HOME INC
Other - Org Name:NORTHERN MANHATTAN REHABILITATION & NURSING CARE CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-426-1284
Mailing Address - Street 1:116 E 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1612
Mailing Address - Country:US
Mailing Address - Phone:212-426-1284
Mailing Address - Fax:212-427-9509
Practice Address - Street 1:116 E 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1612
Practice Address - Country:US
Practice Address - Phone:212-426-1284
Practice Address - Fax:212-427-9509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002355314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01628880Medicaid
NY335792Medicare Oscar/Certification