NPIMap

Organization Active NPI

Menorah Home & Hospital for the Aged & Infirm

  • Skilled Nursing Facility
  • Brooklyn, NY
National Provider Identifier
1922004860
Registry record updated Mar 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
7001372N Issued in NY
Legal business name
MENORAH HOME & HOSPITAL FOR THE AGED & INFIRM
Practice address
1516 Oriental Blvd
Brooklyn, NY 11235-2328
Phone
(718) 646-4441
NPI assigned
Jun 24, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2022

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

Authorized official

Name
Mr. David Wagner
Title
President & Ceo
Phone
(718) 491-7209

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 7001372N NY Primary

Addresses

Primary practice location

1516 Oriental Blvd
Brooklyn, NY 11235-2328

Mailing address

1516 Oriental Blvd
Brooklyn, NY 11235-2328
Phone (718) 646-4441

Other identifiers 2

IdentifierTypeStateIssuer
00708181MedicaidNY
007917OtherNYBC/BS PROVIDER #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090115000458 NY Part A Provider - Skilled Nursing Facility 3577454719 Practice locations: Brooklyn, NY
O20110407000211 NY Part B Supplier - Clinic/Group Practice 3577454719 Receives reassigned benefits from 13 practitioners
Practice locations: Brooklyn, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922004860. Details of each certification follow.

Skilled nursing facility certification: CCN 335653

Legal name
MENORAH HOME & HOSPITAL FOR THE AGED & INFIRM
Doing business as
MENORAH CENTER FOR REHABILITATION AND NURSING CARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 28, 1982
Last certification
Oct 16, 2024
Beds
436
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 16, 1997 in NY
Enrollment address
1516 Oriental Blvd
Brooklyn, NY 11235-2328
Nursing home name
MENORAH HOME & HOSPITAL FOR AGED & INFIRM

Care Compare: Nursing home

Medicare Care Compare
Listed as
Menorah Home & Hospital For Aged & InfirmCCN 335653 · All quality measures
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jun 28, 1982
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
436424.3 residents per day on average
Penalties (3 years)
1Fines totaling $8,018

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0717962Menorah Home and Hospital for the Aged1516 Oriental Blvd, Brooklyn, NY 11235Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Menorah Home and Hospital Adult Day Program4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

871 Bushwick Ave
Brooklyn, NY 11221
Phone (718) 443-3000

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Jessica Wares Individual W-2 Managing EmployeeAdministrator Jul 19, 2021
David Wagner Individual Corporate OfficerChief Executive Officer Jan 1, 2022
Corporate DirectorChief Executive Officer Jan 1, 2022
Anca Adams Individual W-2 Managing EmployeeAssociate General Counsel (Anca Mar 21, 2022
David Koschitzki Individual Corporate OfficerChief Financial Officer Jan 1, 2022

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1922004860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 ORIENTAL BLVD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112352328",
            "telephone_number": "718-646-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 ORIENTAL BLVD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112352328",
            "telephone_number": "718-646-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENORAH HOME & HOSPITAL FOR THE AGED & INFIRM",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-24",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "718-491-7209",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NY",
            "license": "7001372N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00708181",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER #",
            "identifier": "007917",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.