Provider Demographics
NPI:1306882857
Name:PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION
Entity type:Organization
Organization Name:PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-289-2354
Mailing Address - Street 1:27111 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1436
Mailing Address - Country:US
Mailing Address - Phone:718-289-2272
Mailing Address - Fax:718-289-2274
Practice Address - Street 1:27111 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1436
Practice Address - Country:US
Practice Address - Phone:718-289-2272
Practice Address - Fax:718-289-2274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKER JEWISH INSTITUTE FOR HEALTH CARE AND REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-22
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0136723336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00313511Medicaid
3336662OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3336662OtherNCPDP PROVIDER IDENTIFICATION NUMBER