Provider Demographics
NPI:1922004282
Name:DEWITT REHABILITATION AND NURSING CENTER, INC.
Entity Type:Organization
Organization Name:DEWITT REHABILITATION AND NURSING CENTER, INC.
Other - Org Name:UPPER EAST SIDE REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-879-1600
Mailing Address - Street 1:211 E 79TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0891
Mailing Address - Country:US
Mailing Address - Phone:212-879-1600
Mailing Address - Fax:212-879-4594
Practice Address - Street 1:211 EAST 79TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0819
Practice Address - Country:US
Practice Address - Phone:212-879-1600
Practice Address - Fax:212-879-4594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002374N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310421Medicaid
NY335232Medicare Oscar/Certification