NPIMap

Organization Active NPI

Staten Island Care Center

  • Skilled Nursing Facility
  • Staten Island, NY
National Provider Identifier
1447248273
Registry record updated Feb 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
7004314N Issued in NY
Legal business name
STATEN ISLAND CARE CENTER
Practice address
200 Lafayette Ave
Staten Island, NY 10301-1219
Phone
(718) 448-9000
Fax
(718) 448-9184
NPI assigned
Oct 6, 2005
Last updated
Feb 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2012

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

Authorized official

Name
Ms. Shannon M Barback
Title
Medical Records
Phone
(718) 448-9000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 7004314N NY Primary

Addresses

Primary practice location

200 Lafayette Ave
Staten Island, NY 10301-1219

Mailing address

200 Lafayette Ave
Staten Island, NY 10301-1219
Phone (718) 448-9000

Other identifiers 1

IdentifierTypeStateIssuer
00314690MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120126000209 NY Part A Provider - Skilled Nursing Facility 3375710767 Practice locations: Staten Island, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447248273. Details of each certification follow.

Skilled nursing facility certification: CCN 335561001

Legal name
STATEN ISLAND CARE CENTER
Organization structure
LLCProprietary
Enrollment address
200 Lafayette Ave
Staten Island, NY 10301-1219
Nursing home name
STATEN ISLAND CARE CENTER
Affiliated entity
EXCELSIOR CARE GROUP

National Provider Directory

National Provider Directory
Tax ID family
Staten Island Care Center2 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.

Locations

200 Lafayette Ave
Staten Island, NY 10301
Phone (718) 448-3080

200 Lafayette Ave
#A
Staten Island, NY 10301

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Moshe Steinberg Individual Operational/Managerial Control Jul 21, 2019
Managing Control - Governing BodyController Jul 12, 2019
Adp of the SNF Jul 12, 2019
Samuel Stern Individual Corporate OfficerCfo Jan 1, 2017 10%
Akiva Bergman Individual Operational/Managerial Control Jul 19, 2011
Adp of the SNF Jul 19, 2011
Excelsior Care Group Organization, Brooklyn, NY LLC Operational/Managerial Control Jul 21, 2019
Adp of the SNF Oct 28, 2025
Joel Leifer Individual 5% Or Greater Direct Ownership InterestMember Jan 1, 2015 9%
Managing Control - Governing BodyMember Jan 1, 2015
Adp of the SNF Jan 1, 2015
Nissan Gordon Individual Operational/Managerial Control Jul 19, 2021
Adp of the SNF Jul 19, 2021
Constance Leifer Individual 5% Or Greater Direct Ownership InterestExecutive Director Jan 1, 2015 91%
Managing Control - Governing BodyMember Jul 12, 2019
Adp of the SNF Jul 21, 2019
Angela Rose Marie Garcia Individual Operational/Managerial Control Dec 28, 2020
Adp of the SNF Dec 28, 2020

Owners & managing parties with NPI records 1

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

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328832000000",
    "number": "1447248273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 LAFAYETTE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103011219",
            "telephone_number": "718-448-9000",
            "fax_number": "718-448-9184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 LAFAYETTE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103011219",
            "telephone_number": "718-448-9000",
            "fax_number": "718-448-9184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEN ISLAND CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2012-02-10",
        "status": "A",
        "authorized_official_last_name": "BARBACK",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL RECORDS",
        "authorized_official_telephone_number": "718-448-9000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "7004314N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00314690",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.