Provider Demographics
NPI:1699916940
Name:ISABELLA NURSING HOME INC
Entity type:Organization
Organization Name:ISABELLA NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:
Authorized Official - Last Name:MELIAMBRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-342-9308
Mailing Address - Street 1:515 AUDUBON AVE
Mailing Address - Street 2:FINANCE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3403
Mailing Address - Country:US
Mailing Address - Phone:212-342-9308
Mailing Address - Fax:
Practice Address - Street 1:515 AUDUBON AVE
Practice Address - Street 2:FINANCE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3403
Practice Address - Country:US
Practice Address - Phone:212-342-9308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW78731Medicare PIN