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General NPI Number Information
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NPI Number | 1184926594
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Entity Type | Organization
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Legal Business Name | UBODR
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 6136 64TH ST
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-1023
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Country | US
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Telephone | 646-552-8325
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Fax |
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Provider Business Mailing Address
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Address Line | 6136 64TH ST
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-1023
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Country | US
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Telephone | 646-552-8325
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GLORILYN M CORPUZ
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Credential | OTR
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Telephone | 646-552-8325
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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 | 009256-1
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License Number State | NY
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