MEDICARE: MEALS ON WHEELS OF SI, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332U00000X	Home Delivered Meals

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023303047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEALS ON WHEELS OF SI, INC.

Provider Business Mailing Address
First Line	:	304 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1705
Country	:	US
Telephone Number	:	718-727-4435
Fax Number	:	718-727-2157

Provider Business Practice Location Address
First Line	:	304 PORT RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-1705
Country	:	US
Telephone Number	:	718-727-4435
Fax Number	:	718-727-2157

Authorized Official
Title or Position	:	LCSW
Name	:	MR. JOSEPH TORNELLO
Credential	:
Telephone Number	:	718-727-4435

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	06/17/2011

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