Healthcare Provider Details

I. General information

NPI: 1255393195
Provider Name (Legal Business Name): ISLAND HOME CARE AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MONTAUK HWY
SPEONK NY
11972
US

IV. Provider business mailing address

PO BOX 244
SPEONK NY
11972-0244
US

V. Phone/Fax

Practice location:
  • Phone: 631-289-6223
  • Fax: 631-289-7473
Mailing address:
  • Phone: 631-289-6223
  • Fax: 631-289-7473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number9266L001
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1578L001
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number9266L001
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number1578L001
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number9266L001
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1578L001
License Number StateNY

VIII. Authorized Official

Name: JOSEPH PIERRO
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 631-289-6223