Healthcare Provider Details

I. General information

NPI: 1942486089
Provider Name (Legal Business Name): JNJ HOME HEALTH AIDE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5223 AVENUE N
BROOKLYN NY
11234-3907
US

IV. Provider business mailing address

5223 AVENUE N
BROOKLYN NY
11234-3907
US

V. Phone/Fax

Practice location:
  • Phone: 718-377-3201
  • Fax:
Mailing address:
  • Phone: 718-377-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0875L001
License Number StateNY

VIII. Authorized Official

Name: MR. JOSEPH BAZELAIS
Title or Position: CEO
Credential: BIOLOGIST
Phone: 718-377-3201