NPIMap

Organization Active NPI

Hollis Park Manor Nursing Home, Inc.

  • Skilled Nursing Facility
  • Hollis, NY
National Provider Identifier
1295734812
Registry record updated Jun 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HOLLIS PARK MANOR NURSING HOME, INC.
Practice address
19106 Hillside Ave
Hollis, NY 11423-1942
Phone
(718) 479-1010
Fax
(718) 464-8245
NPI assigned
Jul 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2015

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

Authorized official

Name
Mr. Jonathan Gewirtz
Title
Manager, Fiscal Oversight
Phone
(914) 588-8379

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

19106 Hillside Ave
Hollis, NY 11423-1942

Mailing address

19106 Hillside Ave
Hollis, NY 11423-1942
Phone (718) 479-1010

Other identifiers 1

IdentifierTypeStateIssuer
00310054MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111129000708 NY Part A Provider - Skilled Nursing Facility 6305010455 Practice locations: Hollis, NY

Skilled nursing facility certification: CCN 335333

Legal name
HOLLIS PARK MANOR NURSING HOME INC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 14, 1971
Last certification
Jan 23, 2024
Beds
80
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
Apr 20, 1993 in NY
Enrollment address
19106 Hillside Ave
Hollis, NY 11423-1942
Nursing home name
HOLLIS PARK MANOR NURSING HOME

Care Compare: Nursing home

Medicare Care Compare
Listed as
Hollis Park Manor Nursing HomeCCN 335333
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Sep 14, 1971
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8073.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Yosef Ruben Individual 5% Or Greater Direct Ownership Interest Dec 1, 2016 14%
Corporate OfficerSecretary/Treasurer Nov 5, 2012
Jonathan Gewirtz Individual 5% Or Greater Direct Ownership Interest Jun 3, 2015 14%
Corporate Director Jun 3, 2015 14%
Robert Izsak Individual 5% Or Greater Direct Ownership Interest Jun 3, 2015 5%
David Landa Individual Corporate OfficerPresident/Ceo Nov 5, 2012
Operational/Managerial ControlPresident and Ceo Nov 5, 2012
Robert Re Individual 5% Or Greater Direct Ownership Interest Jun 3, 2015 9.5%
Susan Rubin Individual 5% Or Greater Direct Ownership Interest Dec 1, 2016 14%

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1295734812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19106 HILLSIDE AVE",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "114231942",
            "telephone_number": "718-479-1010",
            "fax_number": "718-464-8245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19106 HILLSIDE AVE",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "114231942",
            "telephone_number": "718-479-1010",
            "fax_number": "718-464-8245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLIS PARK MANOR NURSING HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-15",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "GEWIRTZ",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "MANAGER, FISCAL OVERSIGHT",
        "authorized_official_telephone_number": "914-588-8379",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00310054",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollis, NY

Sources for this page

Verify at the official NPI Registry.