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General NPI Number Information
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NPI Number | 1750656021
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Entity Type | Organization
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Legal Business Name | D0E
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 5040 JACOBUS ST
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City | ELMHURST
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State | NY
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Zip | 11373-3702
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Country | US
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Telephone | 718-429-7006
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Fax | 718-429-6864
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Provider Business Mailing Address
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Address Line | 5040 JACOBUS ST
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City | ELMHURST
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State | NY
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Zip | 11373-3702
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Country | US
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Telephone | 718-429-7006
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Fax | 718-429-6864
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Authorized Official
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Title or Position | STAFF NURSE
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Name | MRS. MARIA ANDRES DAULO
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Credential | RN
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Telephone | 718-429-7006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 443418-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 443418-1
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License Number State | NY
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