JBG Holding Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5151316N Issued in NY

Legal business name

JBG HOLDING COMPANY LLC

Practice address

1360 Route 112
Port Jefferson Station, NY 11776-3078

Phone

(631) 473-7100

Fax

(631) 473-7118

NPI assigned

Sep 29, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth Gaul

Title

Administrator

Phone

(631) 473-7100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Woodhaven Nursing Home Doing business as

Locations

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1568459279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 ROUTE 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763078",
            "telephone_number": "631-473-7100",
            "fax_number": "631-473-7118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 ROUTE 112",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763078",
            "telephone_number": "631-473-7100",
            "fax_number": "631-473-7118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JBG HOLDING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "GAUL",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "631-473-7100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "5151316N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00308470",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY OPERATING CERTIFICATE",
            "identifier": "5151316N",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodhaven Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hamid Jabbary, DDS
• Regina L Jablonski, MD
• Robert A Jacobs, M.D.
• James E. Carlson D.O., P.C.
• Jane Salzano LCSW P.C.
• Kemberlie Jeanfrancois
• Jeanne M. Morris-Foley, NP Psychiatry, P.C.
• Saundra Jennings
• Jerry G Ninia MDPC
• Joanne Della Valle LCSW P.C.

• Skilled Nursing Facility in Port Jefferson Station, NY
• Providers in Port Jefferson Station, 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 Feb 24, 2012; 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.