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General NPI Number Information
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NPI Number | 1043639768
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Entity Type | Organization
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Legal Business Name | AMERICAN MEDICAL
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 10 ROY AVE
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City | WEST ISLIP
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State | NY
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Zip | 11795-1316
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Country | US
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Telephone | 151-697-4195
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Fax |
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Provider Business Mailing Address
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Address Line | 10 ROY AVE
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City | WEST ISLIP
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State | NY
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Zip | 11795-1316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | JEAN ANN NICHOLSEN
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Credential |
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Telephone | 516-974-1956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 313020
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License Number State | NY
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