NPIMap

Organization Active NPI

Jefferson Rehabilitation Center

  • Intellectual Disabilities Intermediate Care Facility
  • Watertown, NY
National Provider Identifier
1699982603
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
7642494 Issued in NY
Legal business name
JEFFERSON REHABILITATION CENTER
Practice address
453 Gaffney Dr
Watertown, NY 13601-1834
Phone
(315) 788-3719
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Daniel E. Stern
Title
Executive Director
Phone
(315) 788-2730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 7642494 NY Primary

Addresses

Primary practice location

453 Gaffney Dr
Watertown, NY 13601-1834

Mailing address

PO Box 41
Watertown, NY 13601-0041
Phone (315) 788-2730

Other identifiers 1

IdentifierTypeStateIssuer
01289610MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Jefferson Rehabilitation Center8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

453 Gaffney Dr
Watertown, NY 13601
Phone (315) 788-3719

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699982603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136010041",
            "telephone_number": "315-788-2730",
            "fax_number": "315-788-8557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "453 GAFFNEY DR",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136011834",
            "telephone_number": "315-788-3719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "315-788-2730",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NY",
            "license": "7642494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01289610",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • 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.