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General NPI Number Information
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NPI Number | 1932508991
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Entity Type | Organization
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Legal Business Name | FAMILY PEDIATRIC HOME CARE
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/15/2014
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Provider Practice Location Address
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Address Line | 50 CLINTON STREET SUITE 601
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City | HEMPSTEAD
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State | NY
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Zip | 11550-2314
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Country | US
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Telephone | 516-993-0485
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Fax | 516-993-1923
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Provider Business Mailing Address
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Address Line | 100 TERRACE AVE APT 555
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City | HEMPSTEAD
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State | NY
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Zip | 11550
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Country | US
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Telephone | 516-850-0643
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MS. KADIATU KOROMA
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Credential | NURSING
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Telephone | 516-850-0643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 309696-1
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License Number State | NY
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