Healthcare Provider Details

I. General information

NPI: 1164152948
Provider Name (Legal Business Name): MYCAREONTHEGO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 07/21/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 ROCKAWAY PKWY
BROOKLYN NY
11236-5505
US

IV. Provider business mailing address

1963 ROCKAWAY PKWY
BROOKLYN NY
11236-5505
US

V. Phone/Fax

Practice location:
  • Phone: 347-702-0069
  • Fax: 917-423-0410
Mailing address:
  • Phone: 347-702-0069
  • Fax: 917-423-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER FIELDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 347-702-0069