Healthcare Provider Details

I. General information

NPI: 1396640470
Provider Name (Legal Business Name): ROOTED COMMUNITY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 WALNUT ST
LYNBROOK NY
11563-2029
US

IV. Provider business mailing address

126 WALNUT ST
LYNBROOK NY
11563-2029
US

V. Phone/Fax

Practice location:
  • Phone: 917-519-1151
  • Fax:
Mailing address:
  • Phone: 917-519-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MD ABUBUKAR SIDDIQUE
Title or Position: OWNER
Credential:
Phone: 917-519-1151