MEDICARE: ELECTRIC GRILL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	335G00000X	Medical Foods Supplier
2	332U00000X	Home Delivered Meals
3	174200000X	Meals Provider

General Provider Information

NPI Number	:	1932058609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELECTRIC GRILL

Provider Business Mailing Address
First Line	:	1718 201ST ST
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11360-1019
Country	:	US
Telephone Number	:	718-586-1790
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 38TH ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1709
Country	:	US
Telephone Number	:	718-586-1790
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	BRIAN SONG
Credential	:
Telephone Number	:	718-586-1790

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ELECTRIC GRILL ” Practice Location

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