MEDICARE: NYC INTER CITY HOMECARE AGENCY INC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1427590330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC INTER CITY HOMECARE AGENCY INC

Provider Business Mailing Address
First Line	:	PO BOX 520448
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-0008
Country	:	US
Telephone Number	:	646-309-9960
Fax Number	:

Provider Business Practice Location Address
First Line	:	4755 WHITE PLAINS RD
Second Line	:	APT 6B
City	:	BRONX
State	:	NY
Zip	:	10470-1115
Country	:	US
Telephone Number	:	646-309-9960
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHILLIP K ADUTWUM
Credential	:
Telephone Number	:	646-309-9960

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	11/09/2016

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