MEDICARE: AG TELEHEALTH

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1598456246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AG TELEHEALTH

Provider Business Mailing Address
First Line	:	1231 E 84TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 E 84TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-4911
Country	:	US
Telephone Number	:	718-666-9351
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	ASHLEY BISHOP
Credential	:
Telephone Number	:	718-666-9351

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	05/15/2023

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Directions to “AG TELEHEALTH ” Practice Location

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