Healthcare Provider Details

I. General information

NPI: 1952057051
Provider Name (Legal Business Name): EMPYREAN TEAM H-C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 WINTHROP ST APT 1
BROOKLYN NY
11203-1808
US

IV. Provider business mailing address

699 WINTHROP ST APT 1
BROOKLYN NY
11203-1808
US

V. Phone/Fax

Practice location:
  • Phone: 718-701-1586
  • Fax: 718-701-1295
Mailing address:
  • Phone: 718-701-1586
  • Fax: 718-701-1295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number StateNULL

VIII. Authorized Official

Name: DARLINE ETIENNE
Title or Position: DIRECTOR
Credential: RN
Phone: 718-701-1586