Provider Demographics
NPI:1811986359
Name:NEW EAST SIDE NURSING HOME LLC
Entity type:Organization
Organization Name:NEW EAST SIDE NURSING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CORRADO
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTROPIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-673-8500
Mailing Address - Street 1:25 BIALYSTOKER PL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4008
Mailing Address - Country:US
Mailing Address - Phone:212-673-8500
Mailing Address - Fax:646-602-1684
Practice Address - Street 1:25 BIALYSTOKER PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4008
Practice Address - Country:US
Practice Address - Phone:212-673-8500
Practice Address - Fax:646-602-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00310027Medicaid
NY00310027Medicaid