Niskayuna Operating Co LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

4652301N Issued in NY

Legal business name

NISKAYUNA OPERATING CO LLC

Practice address

1805 Providence Ave
Niskayuna, NY 12309-3923

Phone

(518) 374-2212

Fax

(518) 381-9068

NPI assigned

Aug 26, 2010

Last updated

Aug 26, 2010By 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

Mr. Mathew Varghese, MSN, GNP, LNHA

Title

Executive Director

Phone

(518) 374-2212

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 1356657423. Details of each certification follow.

• CCN 335701001 Skilled nursing facility · Details

Skilled nursing facility certification: CCN 335701001

Legal name

NISKAYUNA OPERATING CO LLC

Doing business as

PATHWAY REHABILITATION AND SPECIAL CARE CENTER

Organization structure

LLCProprietary

Incorporated

Sep 30, 2010 in NY

Enrollment address

1805 Providence Ave
Niskayuna, NY 12309-3923

Nursing home name

PATHWAYS NURSING AND REHABILITATION CENTER

Tax ID family

Highgate LTC Mangement LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Highgate LTC Management LLC

  dba Northwoods Rehab and ECF at Hilltop

  • Skilled Nursing Facility
  • Niskayuna, NY
  • NPI 1962498246
  NPD tax ID
• Niskayuna Operating Company, LLD

  dba Pathways Nursing & Rehabilitation Center

  • Pediatric Skilled Nursing Facility
  • Niskayuna, NY
  • NPI 1326457714
  NPD tax ID

All disclosed owners & managing parties 3

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.

• Roman Koldayev, M.D.

  • Internal Medicine Physician
  • Lawrence, NY
  • NPI 1790766970

  Adp of the SNF, Corporate Director, Operational/Managerial Control

  CMS ownership

Practitioners 1

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.

• Roman Koldayev, M.D.

  • Internal Medicine Physician
  • Lawrence, NY
  • NPI 1790766970
  NPD (past)

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

{
    "created_epoch": "1282780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282780800000",
    "number": "1356657423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 PROVIDENCE AVE",
            "city": "NISKAYUNA",
            "state": "NY",
            "postal_code": "123093923",
            "telephone_number": "518-374-2212",
            "fax_number": "518-381-9068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 PROVIDENCE AVE",
            "city": "NISKAYUNA",
            "state": "NY",
            "postal_code": "123093923",
            "telephone_number": "518-374-2212",
            "fax_number": "518-381-9068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NISKAYUNA OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-26",
        "last_updated": "2010-08-26",
        "status": "A",
        "authorized_official_last_name": "VARGHESE",
        "authorized_official_first_name": "MATHEW",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "518-374-2212",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSN, GNP, LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "4652301N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01122765",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• New York Dialysis Services, Inc. (FMS - Niskayuna Dialysis Center)
• Erica Coughlin Niedbalec, M.D.
• Niskayuna Central School District
• Niskayuna Clare Bridge Operator, Inc. (Brookdale East Niskayuna)
• Niskayuna Life Chiropractic
• Niskayuna Operating Company, LLD (Pathways Nursing & Rehabilitation Center)
• Jeffrey Scott Nissen, PHARM.D.
• Northeast Speech-Language Pathology, P.C. (Northeast Mobile Swallow Imaging)
• Northend Medical Practice PLLC
• Numeriano Go, M.D., P.C.

• Skilled Nursing Facility in Niskayuna, NY
• Providers in Niskayuna, 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 Aug 26, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.