MEDICARE: 121 CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1164930665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	121 CARE LLC

Provider Business Mailing Address
First Line	:	215 E 73RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3653
Country	:	US
Telephone Number	:	855-572-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 E 73RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-3653
Country	:	US
Telephone Number	:	855-572-0400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANDREW CANTWELL PEDTKE
Credential	:
Telephone Number	:	612-910-4164

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	01/18/2018

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Directions to “121 CARE LLC ” Practice Location

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