Healthcare Provider Details

I. General information

NPI: 1134569163
Provider Name (Legal Business Name): EVITA C FRANK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17901 136TH AVE
JAMAICA NY
11434-4105
US

IV. Provider business mailing address

17901 136TH AVE
JAMAICA NY
11434-4105
US

V. Phone/Fax

Practice location:
  • Phone: 718-341-7272
  • Fax:
Mailing address:
  • Phone: 718-341-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number272205
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number272205
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number272205
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number272205
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number272205
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number272205
License Number StateNY

VIII. Authorized Official

Name: MS. EVITA C FRANK
Title or Position: RN
Credential:
Phone: 718-341-7272