Provider Demographics
NPI:1881622785
Name:MIDWAY NURSING HOME, INC.
Entity type:Organization
Organization Name:MIDWAY NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-961-1212
Mailing Address - Street 1:6995 QUEENS MIDTOWN EXPY
Mailing Address - Street 2:EXPRESSWAY
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1922
Mailing Address - Country:US
Mailing Address - Phone:718-961-1212
Mailing Address - Fax:718-461-9484
Practice Address - Street 1:6995 QUEENS MIDTOWN EXPY
Practice Address - Street 2:EXPRESSWAY
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1922
Practice Address - Country:US
Practice Address - Phone:718-961-1212
Practice Address - Fax:718-461-9484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
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
NY00309100Medicaid
NY00309100Medicaid