Provider Demographics
NPI:1801893383
Name:ROSA COPLON JEWISH HOME AND INFIRMARY
Entity type:Organization
Organization Name:ROSA COPLON JEWISH HOME AND INFIRMARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-639-3311
Mailing Address - Street 1:2700 N FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1527
Mailing Address - Country:US
Mailing Address - Phone:716-639-3311
Mailing Address - Fax:716-639-3309
Practice Address - Street 1:2700 N FOREST RD
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1527
Practice Address - Country:US
Practice Address - Phone:716-639-3311
Practice Address - Fax:716-639-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00407543Medicaid
NY00407543Medicaid