New Surfside Nursing Home LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

7003373N Issued in NY

Legal business name

NEW SURFSIDE NURSING HOME LLC

Practice address

2241 New Haven Ave
Far Rockaway, NY 11691-2538

Phone

(718) 471-3400

Fax

(718) 471-2802

NPI assigned

Jun 28, 2005

Last updated

Mar 25, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth Dunn

Title

Controller

Phone

(718) 471-3400

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063419612. Details of each certification follow.

• CCN 335165 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 335165

Legal name

NEW SURFSIDE NURSING HOME LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1967

Last certification

Mar 7, 2025

Beds

183

Ownership / control type

Individual

Organization structure

LLCProprietary

Enrollment address

2241 New Haven Ave
Far Rockaway, NY 11691-2538

Nursing home name

PREMIER NURSING AND REHAB CENTER OF FAR ROCKAWAY

Affiliated entity

BENJAMIN LANDA

Listed as

Premier Nursing and Rehab Center of Far RockawayCCN 335165 · All quality measures

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

3 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Individual

Certified

Jan 1, 1967

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

183175.8 residents per day on average

Chain

Benjamin Landa48 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Tax ID family

New Surfside Nursing Home Adc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• New Surfside Nursing Home Adc

  • Skilled Nursing Facility
  • Elmhurst, NY
  • NPI 1750460358
  NPD tax ID

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Polina Khanina, MD

  • Internal Medicine Physician
  • Far Rockaway, NY
  • NPI 1285679498

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Polina Khanina, MD

  • Internal Medicine Physician
  • Far Rockaway, NY
  • NPI 1285679498
  NPD (past)
• Roman Koldayev, M.D.

  • Internal Medicine Physician
  • Lawrence, NY
  • NPI 1790766970
  NPD (past)
• Adeola R Uthman, M.D.

  • Cardiovascular Disease Physician
  • Brooklyn, NY
  • NPI 1649204959
  NPD (past)

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Roman Koldayev, M.D.

  • Internal Medicine Physician
  • Lawrence, NY
  • NPI 1790766970

  Nursing home

  Care Compare affiliation
• Adeola R Uthman, M.D.

  • Cardiovascular Disease Physician
  • Brooklyn, NY
  • NPI 1649204959

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206403200000",
    "number": "1063419612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2241 NEW HAVEN AVE",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116912538",
            "telephone_number": "718-471-3400",
            "fax_number": "718-471-2802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2241 NEW HAVEN AVE",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116912538",
            "telephone_number": "718-471-3400",
            "fax_number": "718-471-2802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW SURFSIDE NURSING HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2008-03-25",
        "status": "A",
        "authorized_official_last_name": "DUNN",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "718-471-3400"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "7003373N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00309724",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Far Rockaway, NY
• Providers in Far Rockaway, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.