Healthcare Provider Details

I. General information

NPI: 1619108263
Provider Name (Legal Business Name): ADVANCED HEALTH PRO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6706 ROOSEVELT AVE
WOODSIDE NY
11377-2924
US

IV. Provider business mailing address

6706 ROOSEVELT AVE
WOODSIDE NY
11377-2924
US

V. Phone/Fax

Practice location:
  • Phone: 718-476-2010
  • Fax: 718-476-2125
Mailing address:
  • Phone: 718-476-2010
  • Fax: 718-476-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateNY

VIII. Authorized Official

Name: PAUL H RHEE
Title or Position: PRESIDENT
Credential:
Phone: 718-476-2010