Healthcare Provider Details

I. General information

NPI: 1528904174
Provider Name (Legal Business Name): EGO WORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3119 NEWTOWN AVE
ASTORIA NY
11102-1391
US

IV. Provider business mailing address

3119 NEWTOWN AVE
ASTORIA NY
11102-1391
US

V. Phone/Fax

Practice location:
  • Phone: 929-487-3621
  • Fax:
Mailing address:
  • Phone: 929-487-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: STEVEN SUSANTYO
Title or Position: CLO
Credential:
Phone: 929-487-3621