=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891179974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A & J JOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2015
-----------------------------------------------------
Last Update Date | 07/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 280 N BEDFORD RD SUITE 204
-----------------------------------------------------
City | MOUNT KISCO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10549-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-242-0233
-----------------------------------------------------
Fax | 914-242-0389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1650 CONEY ISLAND AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-5808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-242-0233
-----------------------------------------------------
Fax | 914-242-0389
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE SUPERVISOR
-----------------------------------------------------
Name | CHANA SILBER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 347-875-1421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1416L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------