Eden Park Health Services, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

4720301N Issued in NY

Legal business name

EDEN PARK HEALTH SERVICES, INC.

Practice address

136 Parkway Dr
Cobleskill, NY 12043-5150

Phone

(518) 234-3557

NPI assigned

Nov 8, 2006

Last updated

Aug 22, 2020By 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

Robert Glock

Title

President

Phone

(518) 436-4731

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Eden Park Health Care Center Other name

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407926561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 HOLLAND AVE",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122091713",
            "telephone_number": "518-436-4731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 PARKWAY DR",
            "city": "COBLESKILL",
            "state": "NY",
            "postal_code": "120435150",
            "telephone_number": "518-234-3557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN PARK HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GLOCK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-436-4731"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "4720301N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00312318",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eden Park Health Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• B Berenice Dooley, N.P.
• Diane June Douglass, CDN, DTR
• Brendan Patrick Dwyer, FNP
• Sharine M Dymes, DC
• Rebecca R Eckel, MD
• Jeffrey W Edmonds
• Kathleen Michelle Ellis, PT
• Susan Emerson, M.D.
• Sarah Anne Ereio, RD
• Joel Phillip Evans, FNP-BC

• Skilled Nursing Facility in Cobleskill, NY
• Providers in Cobleskill, 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 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.