=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962964288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE ABRAHAM MANBERG ORGANIZATION CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2019
-----------------------------------------------------
Last Update Date | 04/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21110 99TH AVENUE A
-----------------------------------------------------
City | QUEENS VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11429-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-624-2136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 280013
-----------------------------------------------------
City | QUEENS VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11428-0013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-624-2136
-----------------------------------------------------
Fax | 929-600-5678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | OFFEIBEA MANTEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-607-9149
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------