Healthcare Provider Details

I. General information

NPI: 1245758838
Provider Name (Legal Business Name): ELDERVILLE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14803 HILLSIDE AVE STE A
JAMAICA NY
11435-3330
US

IV. Provider business mailing address

74 ROCKHILL RD
ROSLYN HTS NY
11577
US

V. Phone/Fax

Practice location:
  • Phone: 917-842-9742
  • Fax:
Mailing address:
  • Phone: 917-842-9742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHOAIB S MUHAMMAD
Title or Position: PRESIDENT
Credential:
Phone: 917-842-9742