Provider Demographics
NPI:1871772608
Name:MJG NURSING HOME COMPANY, INC
Entity type:Organization
Organization Name:MJG NURSING HOME COMPANY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP HOSPICE & PALLIATIVE CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-921-7948
Mailing Address - Street 1:6323 7TH AVE
Mailing Address - Street 2:PALLIATIVE CARE PROGRAM
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4742
Mailing Address - Country:US
Mailing Address - Phone:718-921-7948
Mailing Address - Fax:
Practice Address - Street 1:6323 7TH AVE
Practice Address - Street 2:PALLIATIVE CARE PROGRAM
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4742
Practice Address - Country:US
Practice Address - Phone:718-921-7948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MJG NURSING HOME COMPANY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7001347N207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW78621Medicare PIN