Organization
FIELDSTON LODGE CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN GEWIRTZ (MANAGER, FISCAL OVERSIGHT)
(914) 588-8379
Entity
Organization
Contact information
Practice address
666 KAPPOCK ST, BRONX, NY 10463-7704
(917) 549-1203
(718) 884-3792
Mailing address
666 KAPPOCK ST, BRONX, NY 10463-7704
(917) 549-1203
(718) 884-3792
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
7000385N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00310605
—
NY
Enumeration date
04/12/2007
Last updated
06/22/2015
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