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General NPI Number Information
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NPI Number | 1780124719
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Entity Type | Organization
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Legal Business Name | SUPREME GENERATION,INC.
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 03/26/2017
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Provider Practice Location Address
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Address Line | 14766 77TH AVE
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City | FLUSHING
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State | NY
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Zip | 11367-3124
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Country | US
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Telephone | 718-841-7100
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Fax | 718-841-7517
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Provider Business Mailing Address
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Address Line | 14766 77TH AVE
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City | FLUSHING
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State | NY
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Zip | 11367-3124
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Country | US
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Telephone | 718-841-7100
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Fax | 718-841-7517
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BORIS GULKAROV
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Credential |
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Telephone | 718-841-7100
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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 | 1728L001
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License Number State | NY
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