Provider Demographics
NPI:1053337865
Name:ROSA COPLONJEWISH HOME AND INFIRMARY
Entity type:Organization
Organization Name:ROSA COPLONJEWISH HOME AND INFIRMARY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-639-3311
Mailing Address - Street 1:2700 N FOREST RD
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1527
Mailing Address - Country:US
Mailing Address - Phone:716-639-3311
Mailing Address - Fax:716-639-3309
Practice Address - Street 1:2700 N FOREST RD
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1527
Practice Address - Country:US
Practice Address - Phone:716-639-3311
Practice Address - Fax:716-639-3309
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSA COPLON JEWISH HOME AND INFIRMARY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY337234Medicare ID - Type Unspecified