Provider Demographics
NPI:1184614398
Name:NORTHERN METROPOLITAN INC
Entity type:Organization
Organization Name:NORTHERN METROPOLITAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:845-352-9000
Mailing Address - Street 1:225 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2715
Mailing Address - Country:US
Mailing Address - Phone:845-352-9000
Mailing Address - Fax:845-352-9082
Practice Address - Street 1:225 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-2715
Practice Address - Country:US
Practice Address - Phone:845-352-9000
Practice Address - Fax:845-352-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
NY4353301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02994512Medicaid
NY00577720Medicaid
NY335380Medicare ID - Type Unspecified