Healthcare Provider Details

I. General information

NPI: 1023946019
Provider Name (Legal Business Name): MED AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 MYRTLE AVE
ALLENHURST NJ
07711-1360
US

IV. Provider business mailing address

613 MYRTLE AVE
ALLENHURST NJ
07711-1360
US

V. Phone/Fax

Practice location:
  • Phone: 718-208-6747
  • Fax:
Mailing address:
  • Phone: 718-208-6747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY MAMIYE
Title or Position: NP
Credential: NP
Phone: 718-208-6747