Organization
D0E
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA ANDRES DAULO RN (STAFF NURSE)
(718) 429-7006
Entity
Organization
Contact information
Practice address
5040 JACOBUS ST, ELMHURST, NY 11373-3702
(718) 429-7006
(718) 429-6864
Mailing address
5040 JACOBUS ST, ELMHURST, NY 11373-3702
(718) 429-7006
(718) 429-6864
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
443418-1
NY
314000000X
Skilled Nursing Facility
Primary
443418-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0440065
—
NY
Enumeration date
03/19/2012
Last updated
03/19/2012
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