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General NPI Number Information
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NPI Number | 1164021887
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Entity Type | Organization
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Legal Business Name | PREFERRED CERTIFIED, LLC
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 4 W PROSPECT AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2027
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Country | US
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Telephone | 914-328-3733
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Fax |
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Provider Business Mailing Address
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Address Line | 2003 CONEY ISLAND AVE
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City | BROOKLYN
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State | NY
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Zip | 11223-2328
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Country | US
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Telephone | 914-328-3733
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JACLYN DIANA
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Credential |
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Telephone | 212-356-4200
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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 |
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License Number State |
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