MEDICARE: MJ-MC HOME HEALTH CARE 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	251E00000X	Home Health Agency	1179L001	NY

General Provider Information

NPI Number	:	1528286150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJ-MC HOME HEALTH CARE AGENCY,INC

Provider Business Mailing Address
First Line	:	1810 JEROME AVE
Second Line	:	1ST FL.
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3621
Country	:	US
Telephone Number	:	718-513-1728
Fax Number	:	718-513-1732

Provider Business Practice Location Address
First Line	:	1810 JEROME AVE.
Second Line	:	1ST . FL.
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3621
Country	:	US
Telephone Number	:	718-513-1728
Fax Number	:	718-513-1732

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. MYRON PYATNYCHUK
Credential	:
Telephone Number	:	718-513-1728

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/22/2020

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