Provider Demographics
NPI:1356434781
Name:JEWISH HOME LIFECARE, MANHATTAN
Entity type:Organization
Organization Name:JEWISH HOME LIFECARE, MANHATTAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RPH
Authorized Official - Phone:718-410-1289
Mailing Address - Street 1:120 W 106TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3923
Mailing Address - Country:US
Mailing Address - Phone:212-870-4972
Mailing Address - Fax:212-870-4982
Practice Address - Street 1:120 W 106TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3923
Practice Address - Country:US
Practice Address - Phone:212-870-4972
Practice Address - Fax:212-870-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X, 333600000X
NY0111113336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2062857OtherPK
NY01551248Medicaid