Healthcare Provider Details

I. General information

NPI: 1265761191
Provider Name (Legal Business Name): MZL HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 EAST MAIN STREET SUITE 216
PATCHOGUE NY
11772
US

IV. Provider business mailing address

1819 EAST 13TH STREET
BROOKLYN NY
11229-2870
US

V. Phone/Fax

Practice location:
  • Phone: 631-699-2160
  • Fax: 631-699-2151
Mailing address:
  • Phone: 718-575-9090
  • Fax: 718-575-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1729L001
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1729L001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerNEW YORK STATE DEPARTMENT OF HEALTH

VIII. Authorized Official

Name: MR. MARTIN HOFMAN
Title or Position: OPERATOR
Credential:
Phone: 718-575-9090