Healthcare Provider Details

I. General information

NPI: 1942444583
Provider Name (Legal Business Name): UNIVERSA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24650 57TH DR
DOUGLASTON NY
11362-1940
US

IV. Provider business mailing address

24650 57TH DR
DOUGLASTON NY
11362-1940
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-3758
  • Fax: 718-428-7427
Mailing address:
  • Phone: 718-224-3758
  • Fax: 718-428-7427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1462L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1462L001
License Number StateNY

VIII. Authorized Official

Name: MRS. GUNJAN P RASTOGI
Title or Position: PRESIDENT
Credential:
Phone: 718-224-3758