=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497345011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNNY TELEHEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2021
-----------------------------------------------------
Last Update Date | 01/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 RIDGE RD
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07071-1216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-504-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2613
-----------------------------------------------------
City | SECAUCUS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07096-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | EMMANUEL RODRIGUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-270-1655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------