Provider Demographics
NPI:1285056457
Name:THE SENIOR PALACE
Entity type:Organization
Organization Name:THE SENIOR PALACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MORDECHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:KRITZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-331-5834
Mailing Address - Street 1:5916 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2335
Mailing Address - Country:US
Mailing Address - Phone:646-331-5834
Mailing Address - Fax:
Practice Address - Street 1:3405 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5374
Practice Address - Country:US
Practice Address - Phone:646-331-5834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care