Healthcare Provider Details

I. General information

NPI: 1154857555
Provider Name (Legal Business Name): ABC HEALTH SERVICE REG. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13340 37TH AVE APT 2
FLUSHING NY
11354-4456
US

IV. Provider business mailing address

13340 37TH AVE APT 2
FLUSHING NY
11354-4456
US

V. Phone/Fax

Practice location:
  • Phone: 718-359-2284
  • Fax: 718-359-3252
Mailing address:
  • Phone: 718-359-2284
  • Fax: 718-359-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number9137L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number9137L001
License Number StateNY

VIII. Authorized Official

Name: MRS. JENNY F. CHAN
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 516-318-8171