Provider Demographics
NPI:1104157866
Name:MICHAEL MALOTZ SKILLED NURSING PAVILLION
Entity type:Organization
Organization Name:MICHAEL MALOTZ SKILLED NURSING PAVILLION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT / CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-964-4723
Mailing Address - Street 1:120 ODELL AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1408
Mailing Address - Country:US
Mailing Address - Phone:914-964-3333
Mailing Address - Fax:914-964-4726
Practice Address - Street 1:120 ODELL AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1408
Practice Address - Country:US
Practice Address - Phone:914-964-3333
Practice Address - Fax:914-964-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100023991Medicare PIN