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General NPI Number Information
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NPI Number | 1871200139
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Entity Type | Organization
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Legal Business Name | 200FLY INC.
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 4255 ROUTE 9 N STE 5C
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City | FREEHOLD
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State | NJ
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Zip | 07728-8305
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Country | US
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Telephone | 732-400-5434
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Fax | 732-702-2462
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Provider Business Mailing Address
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Address Line | 4255 ROUTE 9 N STE 5C
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City | FREEHOLD
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State | NJ
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Zip | 07728-8305
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Country | US
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Telephone | 732-400-5434
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Fax | 732-702-2462
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WAYNE ESPIRITU
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Credential |
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Telephone | 732-400-5125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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