Provider Demographics
NPI:1871582825
Name:BROOKLYN QUEENS NURSING HOME, INC
Entity type:Organization
Organization Name:BROOKLYN QUEENS NURSING HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-277-5100
Mailing Address - Street 1:2749 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-5110
Mailing Address - Country:US
Mailing Address - Phone:718-277-5100
Mailing Address - Fax:718-647-2597
Practice Address - Street 1:2749 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-5110
Practice Address - Country:US
Practice Address - Phone:718-277-5100
Practice Address - Fax:718-647-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001382N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY335637001Medicare Oscar/Certification