Provider Demographics
NPI:1821103813
Name:MICHAEL TENENBAUM
Entity Type:Organization
Organization Name:MICHAEL TENENBAUM
Other - Org Name:RESORT NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-474-5200
Mailing Address - Street 1:430 BEACH 68TH ST
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1407
Mailing Address - Country:US
Mailing Address - Phone:718-474-5200
Mailing Address - Fax:718-474-5214
Practice Address - Street 1:430 BEACH 68TH ST
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1407
Practice Address - Country:US
Practice Address - Phone:718-474-5200
Practice Address - Fax:718-474-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003330N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310554Medicaid
NY1694OtherPFI
NY7003330NOtherLICENSE
NY00310554Medicaid