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General NPI Number Information
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NPI Number | 1396417820
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Entity Type | Individual
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Provider Name | AHJALEE XENOBIA RICHARD716
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Gender | Female
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 26 DUMONT AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1450
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Country | US
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Telephone | 718-667-8511
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Fax |
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Provider Business Mailing Address
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Address Line | 345 THATFORD AVE APT 5R
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City | BROOKLYN
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State | NY
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Zip | 11212-5969
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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 |
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Name |
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Credential |
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Telephone |
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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 | 1652004
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License Number State | NY
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