=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063895902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PIONNER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2015
-----------------------------------------------------
Last Update Date | 07/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 468 KELLER AVE
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-451-1124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 468 KELLER AVE
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-451-1124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPN
-----------------------------------------------------
Name | MRS. MARIE G JEAN-PAUL
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 516-451-1124
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 320774
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------