Organization
MONSIGNOR FITZPATRICK SN PAVILION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SONIA A GORDON (BUSINESS OFFICE MANAGER)
(718) 558-9696
Entity
Organization
Contact information
Practice address
15211 89TH AVE, JAMAICA, NY 11432-3730
(718) 558-9696
(718) 558-2476
Mailing address
15211 89TH AVE, JAMAICA, NY 11432-3730
(718) 558-9696
(718) 558-2476
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
009683
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009683
BLUE CROSS BLUE SHIELD
NY
05
—
01044260
—
NY
01
—
169835
ELDER PLANE
NY
01
—
335689
HIP
NY
Enumeration date
05/10/2007
Last updated
06/25/2008
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