Healthcare Provider Details

I. General information

NPI: 1932058609
Provider Name (Legal Business Name): ELECTRIC GRILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 38TH ST
LONG ISLAND CITY NY
11101-1709
US

IV. Provider business mailing address

1718 201ST ST
BAYSIDE NY
11360-1019
US

V. Phone/Fax

Practice location:
  • Phone: 718-586-1790
  • Fax:
Mailing address:
  • Phone: 718-586-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRIAN SONG
Title or Position: COO
Credential:
Phone: 718-586-1790