Provider Demographics
NPI:1639244742
Name:JEWISH HOME LIFECARE, MANHATTAN
Entity Type:Organization
Organization Name:JEWISH HOME LIFECARE, MANHATTAN
Other - Org Name:THE NEW JEWISH HOME, MANHATTAN - MEDICAL DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-870-4752
Mailing Address - Street 1:120 W 106TH ST
Mailing Address - Street 2:ATTN MEDICAL DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3712
Mailing Address - Country:US
Mailing Address - Phone:212-870-4868
Mailing Address - Fax:
Practice Address - Street 1:120 W 106TH ST
Practice Address - Street 2:ATTN MEDICAL DEPT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3712
Practice Address - Country:US
Practice Address - Phone:212-870-4868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWISH HOME LIFECARE, MANHATTAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-22
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002340N207RG0300X, 208100000X, 2084P0800X, 363L00000X
207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W78831Medicare ID - Type Unspecified