Provider Demographics
NPI:1528354958
Name:HOME ATTENDANT SERVICES OF HYDE PARK
Entity type:Organization
Organization Name:HOME ATTENDANT SERVICES OF HYDE PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-972-5300
Mailing Address - Street 1:1273 53RD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3845
Mailing Address - Country:US
Mailing Address - Phone:718-972-5300
Mailing Address - Fax:718-972-0495
Practice Address - Street 1:1273 53RD ST STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3845
Practice Address - Country:US
Practice Address - Phone:718-972-5300
Practice Address - Fax:718-972-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0874L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00926509Medicaid