Healthcare Provider Details

I. General information

NPI: 1922249283
Provider Name (Legal Business Name): PROMED AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2009
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 EAST 41 STREET
NEWYORK NY
10017
US

IV. Provider business mailing address

1943-76 STREET
BROOKLYN NY
11214
US

V. Phone/Fax

Practice location:
  • Phone: 212-719-9600
  • Fax:
Mailing address:
  • Phone: 718-331-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SALLY PHILLIPS
Title or Position: STAFFING DIRECTOR
Credential:
Phone: 212-719-9600